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General NPI Number Information
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NPI Number | 1679366959
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Entity Type | Organization
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Legal Business Name | SOUTHERN MAGNOLIA ENTERPRISE LLC
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 613 FLEURIE DR
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City | KENNER
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State | LA
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Zip | 70065-1117
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Country | US
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Telephone | 504-644-6334
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Fax |
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Provider Business Mailing Address
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Address Line | 613 FLEURIE DR
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City | KENNER
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State | LA
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Zip | 70065-1117
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Country | US
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Telephone | 504-644-6334
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DONALD HACKETT
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Credential |
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Telephone | 504-644-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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