Provider Demographics
NPI:1720828395
Name:MAGNOLIA ENT, LLC
Entity type:Organization
Organization Name:MAGNOLIA ENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:H
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-427-1499
Mailing Address - Street 1:1000 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3520
Mailing Address - Country:US
Mailing Address - Phone:404-725-8786
Mailing Address - Fax:770-615-5017
Practice Address - Street 1:1000 COMMERCE DR STE 200
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3520
Practice Address - Country:US
Practice Address - Phone:470-489-0090
Practice Address - Fax:470-489-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty