Provider Demographics
NPI:1326870361
Name:MAGNOLIA MEDICAL HOUSE CALLS, PLLC
Entity type:Organization
Organization Name:MAGNOLIA MEDICAL HOUSE CALLS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:334-218-0160
Mailing Address - Street 1:850 TUSCALOOSA ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:36744-1562
Mailing Address - Country:US
Mailing Address - Phone:601-832-0662
Mailing Address - Fax:
Practice Address - Street 1:850 TUSCALOOSA ST STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-1562
Practice Address - Country:US
Practice Address - Phone:601-832-0662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care