Provider Demographics
NPI:1316754211
Name:MAGNOLIA SPRINGS FAMILY PRACTICE
Entity type:Organization
Organization Name:MAGNOLIA SPRINGS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP, OWNER/OPERATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:912-655-5614
Mailing Address - Street 1:626 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2453
Mailing Address - Country:US
Mailing Address - Phone:912-655-5614
Mailing Address - Fax:912-358-1501
Practice Address - Street 1:1102 E 55TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-4612
Practice Address - Country:US
Practice Address - Phone:912-655-5614
Practice Address - Fax:912-358-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service