Provider Demographics
NPI:1497890073
Name:MAGNER, MEREDITH P (PA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:P
Last Name:MAGNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 GLENRIDGE DR NE # B
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5380
Mailing Address - Country:US
Mailing Address - Phone:404-659-5909
Mailing Address - Fax:770-399-9449
Practice Address - Street 1:2675 MAIN ST W
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3161
Practice Address - Country:US
Practice Address - Phone:404-659-5909
Practice Address - Fax:770-399-9449
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004230363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
97WCFVWMedicare ID - Type Unspecified
Q25447Medicare UPIN