Provider Demographics
NPI:1366976987
Name:MAGISTRO, CALEB (AGNP-C)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:MAGISTRO
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 CHESHIRE BRIDGE RD NE UNIT A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4234
Mailing Address - Country:US
Mailing Address - Phone:404-273-2807
Mailing Address - Fax:
Practice Address - Street 1:2215 CHESHIRE BRIDGE RD NE UNIT A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4234
Practice Address - Country:US
Practice Address - Phone:404-273-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210284163W00000X
GAAG0616142363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse