Healthcare Provider Details

I. General information

NPI: 1144080060
Provider Name (Legal Business Name): MAGNOLIA HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 E BRAINERD RD
CHATTANOOGA TN
37421-3940
US

IV. Provider business mailing address

2906 OCOEE ST N
CLEVELAND TN
37312-5376
US

V. Phone/Fax

Practice location:
  • Phone: 423-643-2277
  • Fax: 423-643-2666
Mailing address:
  • Phone: 423-790-5000
  • Fax: 423-643-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWN RAYMOND JONES
Title or Position: OWNER
Credential: DC
Phone: 423-320-1111