Provider Demographics
NPI:1083720411
Name:NELSON, MAGALIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGALIE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-8991
Mailing Address - Country:US
Mailing Address - Phone:229-435-7161
Mailing Address - Fax:229-438-8588
Practice Address - Street 1:605 POINTE NORTH BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-1514
Practice Address - Country:US
Practice Address - Phone:229-435-7161
Practice Address - Fax:229-438-8588
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067777207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126322DMedicaid
GA202I048005Medicare PIN