Healthcare Provider Details

I. General information

NPI: 1295614907
Provider Name (Legal Business Name): MAGNOLIA ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 SOQUE RIVER DR
DULUTH GA
30097-8100
US

IV. Provider business mailing address

2615 PEACHTREE INDUSTRIAL BLVD STE J #2138
DULUTH GA
30097
US

V. Phone/Fax

Practice location:
  • Phone: 770-706-2195
  • Fax:
Mailing address:
  • Phone: 770-706-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MARIA SOCORRO SMITH
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 770-706-2195