Provider Demographics
NPI:1265051973
Name:MAGNUSON, KATHERINE STARRETT (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:STARRETT
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MEDICAL DR STE 405
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4145
Mailing Address - Country:US
Mailing Address - Phone:706-803-7690
Mailing Address - Fax:706-803-8803
Practice Address - Street 1:303 MEDICAL DR STE 405
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4145
Practice Address - Country:US
Practice Address - Phone:706-803-7690
Practice Address - Fax:706-803-8803
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101094207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty