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General NPI Number Information
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NPI Number | 1306630801
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Entity Type | Organization
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Legal Business Name | MAGNOLIA COMFORT MEDICAL SOUTH LLC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 7193 JONESBORO RD STE 101-102
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City | MORROW
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State | GA
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Zip | 30260-2961
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Country | US
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Telephone | 470-726-1699
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Fax |
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Provider Business Mailing Address
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Address Line | 7193 JONESBORO RD STE 101-102
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City | MORROW
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State | GA
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Zip | 30260-2961
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Country | US
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Telephone | 470-726-1699
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR / OWNER
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Name | KEVIN LE
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Credential |
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Telephone | 678-268-8891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 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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