Healthcare Provider Details

I. General information

NPI: 1346131604
Provider Name (Legal Business Name): MAGNOLIA WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CALUMET PKWY STE M200
NEWNAN GA
30263-6736
US

IV. Provider business mailing address

1215 HIGHTOWER TRL STE B100
ATLANTA GA
30350-6237
US

V. Phone/Fax

Practice location:
  • Phone: 970-590-2432
  • Fax:
Mailing address:
  • Phone: 970-590-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASEY ARMIGER
Title or Position: OWNER
Credential:
Phone: 970-590-2432