Provider Demographics
NPI:1740534791
Name:MAGNIFICAT FAMILY CARE
Entity type:Organization
Organization Name:MAGNIFICAT FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMERO MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-526-5560
Mailing Address - Street 1:137 W ATHENS STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1710
Mailing Address - Country:US
Mailing Address - Phone:678-963-5666
Mailing Address - Fax:
Practice Address - Street 1:137 W ATHENS STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1710
Practice Address - Country:US
Practice Address - Phone:678-963-5666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68283261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty