Provider Demographics
NPI:1205013141
Name:MAGEE, KRISTIN HENDREN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:HENDREN
Last Name:MAGEE
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 1:3025 ARBOR CHASE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1800
Mailing Address - Country:US
Mailing Address - Phone:770-723-9541
Mailing Address - Fax:
Practice Address - Street 1:9900 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2017
Practice Address - Country:US
Practice Address - Phone:770-497-0699
Practice Address - Fax:770-497-0388
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060932207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I070061Medicare PIN