Provider Demographics
NPI:1164551503
Name:MAGELLAN HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:MAGELLAN HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NISHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA-DAYA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:800-201-8316
Mailing Address - Street 1:2785 OAK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2794
Mailing Address - Country:US
Mailing Address - Phone:770-736-9988
Mailing Address - Fax:
Practice Address - Street 1:2550 NORTHWINDS PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-2241
Practice Address - Country:US
Practice Address - Phone:800-201-8316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002776302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization