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General NPI Number Information
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NPI Number | 1558332114
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Entity Type | Organization
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Legal Business Name | MAGNOLIA FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 611 CAMPUS DR SUITE 200
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City | ABINGDON
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State | VA
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Zip | 24210-9700
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Country | US
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Telephone | 276-676-1133
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Fax | 276-676-1115
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Provider Business Mailing Address
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Address Line | 611 CAMPUS DR SUITE 200
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City | ABINGDON
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State | VA
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Zip | 24210-9700
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Country | US
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Telephone | 276-676-1133
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Fax | 276-676-1115
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CHERISE D. TRIPLETT
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Credential |
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Telephone | 276-676-1133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 207QA00000X
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License Number State | VA
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