MEDICARE: MAGNOLIA ADULT CARE LLC

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	372600000X	Adult Companion
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1295614907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA ADULT CARE LLC

Provider Business Mailing Address
First Line	:	2615 PEACHTREE INDUSTRIAL BLVD
Second Line	:	STE J #2138
City	:	DULUTH
State	:	GA
Zip	:	30097
Country	:	US
Telephone Number	:	770-706-2195
Fax Number	:

Provider Business Practice Location Address
First Line	:	2176 SOQUE RIVER DR
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8100
Country	:	US
Telephone Number	:	770-706-2195
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MARIA SOCORRO SMITH
Credential	:
Telephone Number	:	770-706-2195

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	05/05/2026

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