| Magnolia Medical Group, Llc | |
|
101 Chase Ct Nw Suite B Milledgeville GA 31061-7186 | |
| (478) 453-2341 | |
| (866) 720-5313 |
| Full Name | Magnolia Medical Group, Llc |
|---|---|
| Speciality | General Practice |
| Location | 101 Chase Ct Nw, Milledgeville, Georgia |
| Authorized Official Name and Position | Justin Lance (DOCTOR/OWNER) |
| Authorized Official Contact | 4784532341 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Medical Group, Llc 101 Chase Ct Nw Suite B Milledgeville GA 31061-7186 Ph: (478) 453-2341 | Magnolia Medical Group, Llc 101 Chase Ct Nw Suite B Milledgeville GA 31061-7186 Ph: (478) 453-2341 |
| NPI Number | 1801340856 |
|---|---|
| Provider Enumeration Date | 08/08/2016 |
| Last Update Date | 08/08/2016 |
| Medicare PECOS PAC ID | 5799066387 |
|---|---|
| Medicare Enrollment ID | O20161219001375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801340856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ME53031 (Georgia) | Primary |
| Provider Name | Casey R Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003151028 PECOS PAC ID: 9436302619 Enrollment ID: I20130122000341 |
| Provider Name | Tiffany Quinton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275994261 PECOS PAC ID: 3274803200 Enrollment ID: I20170724002347 |
| Provider Name | Gregory D Bennett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366651507 PECOS PAC ID: 1850466210 Enrollment ID: I20180820000034 |
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