MAGNOLIA MEDICAL GROUP, LLC (NPI# 1801340856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801340856 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA MEDICAL GROUP, LLC |
| Practice Address |
101 Chase Ct Nw Suite B Milledgeville GA 31061-7186 |
| Practice Telephone | 4784532341 |
| Practice Fax Number | 8667205313 |
| Mailing Telephone | 4784532341 |
| Mailing Fax Number | 8667205313 |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2016-08-08 |
| Authorized Official Name | DR. JUSTIN LANCE (DOCTOR/OWNER) |
| Authorized Official Telephone | 4784532341 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | ME53031 | GA | Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MAGNOLIA MEDICAL GROUP, LLC | 101 Chase Court Nw Ste B, Milledgeville, GA 31061-7188 |
| Street Address |
101 CHASE CT NW SUITE B |
| City | MILLEDGEVILLE |
| State | GA |
| Zip Code | 31061-7186 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942233473 | Personal Safety Specialists | Durable Medical Equipment & Medical Supplies | 101 Chase Ct Nw, Unit D, Milledgeville, GA 31061-7186 | 2006-07-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861007403 | Caring Clinic LLC | Nurse Practitioner | 114 Wrights Dr, Milledgeville, GA 31061 | 2020-09-10 |
| 1629619945 | Gini M Ellis | Counselor | Blandy Way Office Park 60, Highway 22 West, Milledgeville, GA 31061 | 2019-10-08 |
| 1356992275 | Community Health Care Systems, Inc | Clinic/Center | 100 N Abc Street, Milledgeville, GA 31061 | 2019-09-23 |
| 1467923805 | Adam Tocio | Specialist/Technologist | 350 W. Washington St., Milledgeville, GA 31061 | 2018-12-11 |
| 1487170304 | Aubrey Martin | Specialist/Technologist | 251 S Clark St., Milledgeville, GA 31061 | 2017-08-22 |
| 1427573054 | Heritagefirst Home Care Inc. | In Home Supportive Care | 1277 Twin Pine Road, Milledgeville, GA 31061 | 2017-08-04 |
| 1851813893 | Brittany Shantrel Primas | Nurse Practitioner | 102 A Airport Road Ne, Milledgeville, GA 31061 | 2017-07-12 |
| 1609300839 | Samantha Weldon | Behavioral Analyst | 174 Stewart Dr Nw, Milledgeville, GA 31061 | 2017-04-14 |
| 1427425230 | Foster Deariso | Specialist/Technologist | 251 S Clarke St, Milledgeville, GA 31061 | 2015-08-27 |
| 1023406279 | Llewelyn Garillos | Occupational Therapist | 3789 Sinclair Dam Road Ne, Milledgeville, GA 31061 | 2014-12-22 |
| Find all providers in zip 31061 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811507247 | Magnolia Medical Center LLC | General Practice | 101 Chase Ct Nw Ste B, Milledgeville, GA 31061-7188 | 2020-07-31 |
| 1366847790 | Fasttrack Immediate Care of Milledgeville LLC | General Practice | 1909 N Columbia St, Milledgeville, GA 31061-2170 | 2014-10-28 |
| 1740462399 | Wigberto Vivas | General Practice | 620 Broad St, Milledgeville, GA 31062-7525 | 2007-12-05 |
| 1336350750 | Ernesto A Coligado | General Practice | 620 Broad St, Central State Hospital, Milledgeville, GA 31062-7525 | 2007-05-25 |
| 1578679122 | Yonghua Du | General Practice | 620 Broad St, Central State Hospital, Milledgeville, GA 31062-7525 | 2006-08-23 |
| 1841202769 | William Deferia | General Practice | 620 Broad St, Central State Hospital, Milledgeville, GA 31062-7525 | 2006-08-12 |
| 1437161924 | David D Steelman | General Practice | 620 Broad St, Central State Hospital, Milledgeville, GA 31062-7525 | 2006-08-12 |
| 1154333946 | Armando C Santiago | General Practice | 620 Broad St, Central State Hospital, Milledgeville, GA 31062-7525 | 2006-08-12 |
| 1710995113 | Ikechukwu S Akunwanne | General Practice | 620 Broad St, Central State Hospital, Milledgeville, GA 31062-7525 | 2006-08-03 |
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| Find all providers with the same taxonomy | ||||
| City | MILLEDGEVILLE |
| Zip Code | 31061 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.