Provider Demographics
NPI:1649058249
Name:MAGEE, DEWAYNE ALVIN SR
Entity type:Individual
Prefix:MR
First Name:DEWAYNE
Middle Name:ALVIN
Last Name:MAGEE
Suffix:SR
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 1:8679 WALWORTH CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-7033
Mailing Address - Country:US
Mailing Address - Phone:404-734-0831
Mailing Address - Fax:
Practice Address - Street 1:8679 WALWORTH CT
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-7033
Practice Address - Country:US
Practice Address - Phone:404-734-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052911623172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty