Healthcare Provider Details

I. General information

NPI: 1952101321
Provider Name (Legal Business Name): MAGNOLIA HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2025
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E TRADE ST STE B100
FOREST CITY NC
28043-2201
US

IV. Provider business mailing address

PO BOX 335
FOREST CITY NC
28043-0335
US

V. Phone/Fax

Practice location:
  • Phone: 828-220-4174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON SHUFORD MOORE
Title or Position: OWNER
Credential:
Phone: 828-220-4171