# M.G.T RN LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MGT MD at Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003448952
- **Authorized official:** MS. JAMEELAH WILSON FNP (OWNER)
- **Authorized official phone:** (480) 430-0721

## Contact information

- **Practice address:** 7117 E PERALTA CIR, MESA, AZ 85212-9825
- **Practice address phone:** (480) 430-0721
- **Mailing address:** 7316 E SOUTHERN AVE UNIT 6091, MESA, AZ 85216-5005
- **Mailing address phone:** (480) 430-0721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/09/2020
- **Last updated:** 02/09/2020