Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 067777 | GA |
NPI | 1083720411 |
---|---|
Provider Name | Dr. Magalie Nelson |
First Address | Albany, GA 31721-8991 |
Second Address | Albany, GA 31721-1514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 24/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003126322D | (05) | GA |