Provider Demographics
NPI:1497882906
Name:MAGNER, ROSEMARY (NP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:MAGNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 RIDENOUR PKWY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4511
Mailing Address - Country:US
Mailing Address - Phone:678-290-3214
Mailing Address - Fax:
Practice Address - Street 1:2988 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3033
Practice Address - Country:US
Practice Address - Phone:866-935-0333
Practice Address - Fax:713-935-9353
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA116763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner