Provider Demographics
NPI:1043036585
Name:MAGEE, DEMETRIC D (NURSE ASSISNTANT)
Entity type:Individual
Prefix:
First Name:DEMETRIC
Middle Name:D
Last Name:MAGEE
Suffix:
Gender:F
Credentials:NURSE ASSISNTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7288 FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-2869
Mailing Address - Country:US
Mailing Address - Phone:228-215-1672
Mailing Address - Fax:228-233-3172
Practice Address - Street 1:7288 FRANCIS DR
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-2869
Practice Address - Country:US
Practice Address - Phone:228-215-1672
Practice Address - Fax:228-233-3172
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS79900376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty