Provider Demographics
NPI:1407373590
Name:MAGALLANO, ALLIE (CNM)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:MAGALLANO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 FORSYTH ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8639
Mailing Address - Country:US
Mailing Address - Phone:478-742-6738
Mailing Address - Fax:
Practice Address - Street 1:1062 FORSYTH ST STE 2A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8639
Practice Address - Country:US
Practice Address - Phone:478-742-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223097367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife