Provider Demographics
NPI:1427524693
Name:HENRY, MAGEN (DC)
Entity type:Individual
Prefix:DR
First Name:MAGEN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WOODLANDS DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8422
Mailing Address - Country:US
Mailing Address - Phone:678-467-9413
Mailing Address - Fax:
Practice Address - Street 1:1675 CUMBERLAND PKWY SE STE 205
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6360
Practice Address - Country:US
Practice Address - Phone:678-467-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty