Provider Demographics
NPI:1043390586
Name:MAGILL, SHELLEY S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:S
Last Name:MAGILL
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 MARKAN DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2305
Mailing Address - Country:US
Mailing Address - Phone:404-575-2170
Mailing Address - Fax:
Practice Address - Street 1:CDC, MYCOTIC DISEASES BRANCH
Practice Address - Street 2:1600 CLIFTON ROAD, MAILSTOP C-09
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30333
Practice Address - Country:US
Practice Address - Phone:404-639-3548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57343207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH89310Medicare UPIN
MDKR70G651Medicare ID - Type Unspecified