Provider Demographics
NPI:1750473518
Name:MCGONAGLE, MARGIE KAY (RD,MS,LDN)
Entity Type:Individual
Prefix:MS
First Name:MARGIE
Middle Name:KAY
Last Name:MCGONAGLE
Suffix:
Gender:F
Credentials:RD,MS,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4000
Mailing Address - Street 2:CORNER OF SIDNEY AND LAMONT (JOHNSON CITY)
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-4000
Mailing Address - Country:US
Mailing Address - Phone:423-979-2678
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF SIDNEY AND LAMONT (JOHNSON CITY)
Practice Address - Street 2:JAMES H QUILLEN/VAMC
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-4000
Practice Address - Country:US
Practice Address - Phone:423-979-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN583133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered