MEDICARE: MAGNOLIA BLOOM BEHAVIOR SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1093549958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA BLOOM BEHAVIOR SOLUTIONS

Provider Business Mailing Address
First Line	:	823 BROAD ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-1214
Country	:	US
Telephone Number	:	706-993-3829
Fax Number	:	706-955-1048

Provider Business Practice Location Address
First Line	:	823 BROAD ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-1214
Country	:	US
Telephone Number	:	706-993-3829
Fax Number	:	706-955-1048

Authorized Official
Title or Position	:	ADMINISTRATIVE OWNING PARTNER
Name	:	SARAH BUEHRER
Credential	:
Telephone Number	:	706-993-3829

Provider Enumeration Date	:	08/31/2024
Last Update Date	:	04/04/2025

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