Provider Demographics
NPI:1750446829
Name:DAVID M. MAGAS, M.D.
Entity Type:Organization
Organization Name:DAVID M. MAGAS, M.D.
Other - Org Name:COLLINWOOD MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MANDRESA
Authorized Official - Last Name:MAGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-724-9135
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:902 HWY 13 S
Mailing Address - City:COLLINWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:38450-0215
Mailing Address - Country:US
Mailing Address - Phone:931-724-9135
Mailing Address - Fax:931-724-4572
Practice Address - Street 1:902 HWY 13 S
Practice Address - Street 2:
Practice Address - City:COLLINWOOD
Practice Address - State:TN
Practice Address - Zip Code:38450-0215
Practice Address - Country:US
Practice Address - Phone:931-724-9135
Practice Address - Fax:931-724-4572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3028025Medicaid
TN3028025Medicaid
TNB58992Medicare UPIN