Provider Demographics
NPI:1164549283
Name:MAGAT, ABELARDO B (MD)
Entity Type:Individual
Prefix:DR
First Name:ABELARDO
Middle Name:B
Last Name:MAGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6911 TARA BLVD # A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1503
Mailing Address - Country:US
Mailing Address - Phone:770-477-8573
Mailing Address - Fax:770-477-9045
Practice Address - Street 1:6911 TARA BLVD # A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1503
Practice Address - Country:US
Practice Address - Phone:770-477-8573
Practice Address - Fax:770-477-9045
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018045208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10033951OtherAMERIGROUP
GA10033951OtherAMERIGROUP
GA02BDBSGMedicare ID - Type Unspecified