Provider Demographics
NPI:1205161791
Name:MAGDALENE INC
Entity type:Organization
Organization Name:MAGDALENE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-267-9900
Mailing Address - Street 1:4420 ALTAMA AVE.
Mailing Address - Street 2:STE. 40
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520
Mailing Address - Country:US
Mailing Address - Phone:912-267-9900
Mailing Address - Fax:912-267-9901
Practice Address - Street 1:4420 ALTAMA AVE
Practice Address - Street 2:STE. 40
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3020
Practice Address - Country:US
Practice Address - Phone:912-267-9900
Practice Address - Fax:912-267-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15005261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center