Provider Demographics
NPI:1245284041
Name:ATTIA, MAGDY (DMD)
Entity type:Individual
Prefix:
First Name:MAGDY
Middle Name:
Last Name:ATTIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WEST LANIER AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:770-461-7700
Mailing Address - Fax:770-461-7750
Practice Address - Street 1:30 WARREN ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317
Practice Address - Country:US
Practice Address - Phone:404-370-7360
Practice Address - Fax:404-370-7379
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0124251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA025496141BMedicaid
GA025496141AMedicaid