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General NPI Number Information
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NPI Number | 1295614907
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Entity Type | Organization
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Legal Business Name | MAGNOLIA ADULT CARE LLC
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2176 SOQUE RIVER DR
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City | DULUTH
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State | GA
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Zip | 30097-8100
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Country | US
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Telephone | 770-706-2195
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 PEACHTREE INDUSTRIAL BLVD STE J #2138
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City | DULUTH
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State | GA
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Zip | 30097
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Country | US
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Telephone | 770-706-2195
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MARIA SOCORRO SMITH
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Credential |
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Telephone | 770-706-2195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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