Mga, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-033-1720 Issued in GA

Legal business name

MGA, LLC

Practice address

811 Kennesaw Ave NW
Marietta, GA 30060-1002

Phone

(770) 422-2451

Fax

(770) 426-0462

NPI assigned

Jul 3, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul M Walczak

Title

Ceo

Phone

(561) 627-0664

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215135041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2979 PGA BLVD",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334102911",
            "telephone_number": "561-627-0664",
            "fax_number": "561-627-2867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 KENNESAW AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601002",
            "telephone_number": "770-422-2451",
            "fax_number": "770-426-0462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MGA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALCZAK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-627-0664",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-033-1720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.