Provider Demographics
NPI:1386441194
Name:MAGNOLIA SPEECH THERAPY ASSOCIATES
Entity type:Organization
Organization Name:MAGNOLIA SPEECH THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:678-340-9305
Mailing Address - Street 1:19 PERRY ST STE B01
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1918
Mailing Address - Country:US
Mailing Address - Phone:678-340-9305
Mailing Address - Fax:
Practice Address - Street 1:19 PERRY ST STE B01
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1918
Practice Address - Country:US
Practice Address - Phone:678-340-9305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty