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NPI Code Detail

MEDICARE: MAGNOLIA HEALTH CLINIC

MEDICARE: MAGNOLIA HEALTH CLINIC
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
1261QP2300XPrimary Care Clinic/Center00222568GA

General Provider Information

NPI Number : 1487047049
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGNOLIA HEALTH CLINIC
Provider Business Mailing Address
First Line : 3350 NORTHLAKE PKWY NE
Second Line : SUITE B
City : ATLANTA
State : GA
Zip : 30345-2204
Country : US
Telephone Number : 770-724-8093
Fax Number :
Provider Business Practice Location Address
First Line : 3350 NORTHLAKE PKWY NE
Second Line : SUITE B
City : ATLANTA
State : GA
Zip : 30345-2204
Country : US
Telephone Number : 770-724-8093
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. MIRA IHEME
Credential : PH.D., LPC
Telephone Number : 770-724-8093
Provider Enumeration Date : 03/06/2015
Last Update Date : 03/06/2015

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Directions to “MAGNOLIA HEALTH CLINIC ” Practice Location

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