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General NPI Number Information
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NPI Number | 1316754211
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Entity Type | Organization
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Legal Business Name | MAGNOLIA SPRINGS FAMILY PRACTICE
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 1102 E 55TH ST
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City | SAVANNAH
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State | GA
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Zip | 31404-4612
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Country | US
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Telephone | 912-655-5614
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Fax | 912-358-1501
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Provider Business Mailing Address
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Address Line | 626 E 49TH ST
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City | SAVANNAH
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State | GA
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Zip | 31405-2453
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Country | US
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Telephone | 912-655-5614
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Fax | 912-358-1501
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Authorized Official
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Title or Position | NP, OWNER/OPERATOR/CEO
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Name | ERIN M HIVELY
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Credential | FNP-BC
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Telephone | 912-655-5614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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