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General NPI Number Information
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NPI Number | 1689323776
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Entity Type | Organization
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Legal Business Name | MAGNOLIA FAMILY MEDICINE AND WELLNESS
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 1402 WILLOW DR
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City | MANCHESTER
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State | TN
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Zip | 37355-2438
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Country | US
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Telephone | 931-450-1000
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Fax | 931-450-1004
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Provider Business Mailing Address
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Address Line | 1344 MCBRIDES BRANCH RD
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City | BEECHGROVE
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State | TN
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Zip | 37018-3718
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Country | US
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Telephone | 931-212-1479
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Fax |
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. VANESSA STREICHER GREEN
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Credential | DO
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Telephone | 931-212-1479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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