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General NPI Number Information
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NPI Number | 1154940906
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Entity Type | Organization
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Legal Business Name | MAGNOLIA COMFORT MEDICAL LLC
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Dates
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Enumeration Date | 04/12/2020
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 6050 PEACHTREE PARKWAY, STE 420
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-3336
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Country | US
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Telephone | 470-545-0275
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Fax | 470-246-5961
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Provider Business Mailing Address
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Address Line | 6050 PEACHTREE PARKWAY, STE 420
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-3336
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Country | US
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Telephone | 470-545-0275
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Fax | 470-246-5961
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN T LE
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Credential | DC
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Telephone | 470-545-0275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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