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NPI Code Detail

MEDICARE: MAGILL THERAPY LLC

MEDICARE: MAGILL THERAPY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCSW003452GA

General Provider Information

NPI Number : 1114398260
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGILL THERAPY LLC
Provider Business Mailing Address
First Line : 5885 GLENRIDGE DR
Second Line : SUITE 140
City : SANDY SPRINGS
State : GA
Zip : 30328-5512
Country : US
Telephone Number : 404-219-2412
Fax Number : 404-745-0311
Provider Business Practice Location Address
First Line : 5885 GLENRIDGE DR
Second Line : SUITE 140
City : SANDY SPRINGS
State : GA
Zip : 30328-5512
Country : US
Telephone Number : 404-219-2412
Fax Number : 404-745-0311
Authorized Official
Title or Position : OWNER
Name : MR. WILLIAM MAGILL
Credential : LCSW
Telephone Number : 404-219-2412
Provider Enumeration Date : 10/15/2015
Last Update Date : 10/15/2015

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