Provider Demographics
NPI:1770839607
Name:SANDRA L. MAGER, M.D.P.C.
Entity Type:Organization
Organization Name:SANDRA L. MAGER, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-588-1020
Mailing Address - Street 1:114 W. CHERRY STREET
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545
Mailing Address - Country:US
Mailing Address - Phone:912-588-1020
Mailing Address - Fax:912-588-1002
Practice Address - Street 1:114 W. CHERRY STREET
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545
Practice Address - Country:US
Practice Address - Phone:912-588-1020
Practice Address - Fax:912-588-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38043207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000619297BMedicaid
GA16BDTTZMedicare PIN