Provider Demographics
NPI:1255756631
Name:MAGILL, URIAH GABRIEL
Entity type:Individual
Prefix:MR
First Name:URIAH
Middle Name:GABRIEL
Last Name:MAGILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205A SWEET BAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2535
Mailing Address - Country:US
Mailing Address - Phone:573-619-5847
Mailing Address - Fax:
Practice Address - Street 1:2205A SWEET BAY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2535
Practice Address - Country:US
Practice Address - Phone:573-619-5847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235393367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered