Provider Demographics
NPI:1912976846
Name:MAGER, SANDRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:MAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-0664
Mailing Address - Country:US
Mailing Address - Phone:912-588-1020
Mailing Address - Fax:912-588-1002
Practice Address - Street 1:114 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1309
Practice Address - Country:US
Practice Address - Phone:912-588-1020
Practice Address - Fax:912-588-1002
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038043207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000619297BMedicaid
GA16BDTTZMedicare ID - Type Unspecified