Provider Demographics
NPI:1033479340
Name:PHILOSSAINT, MAGDANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAGDANA
Middle Name:
Last Name:PHILOSSAINT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7886 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-6851
Mailing Address - Country:US
Mailing Address - Phone:678-826-7554
Mailing Address - Fax:
Practice Address - Street 1:9991 COMMERCE ST.
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747
Practice Address - Country:US
Practice Address - Phone:678-826-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0046901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical