Provider Demographics
NPI:1821131988
Name:MAGDALENE LIMA-FIALLOS
Entity Type:Organization
Organization Name:MAGDALENE LIMA-FIALLOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMA-FIALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-344-6691
Mailing Address - Street 1:1211 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1935
Mailing Address - Country:US
Mailing Address - Phone:229-439-8686
Mailing Address - Fax:229-883-4484
Practice Address - Street 1:1211 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1935
Practice Address - Country:US
Practice Address - Phone:229-439-8686
Practice Address - Fax:229-883-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty