| Magnolia Med Management, Llc | |
|
2295 Parklake Dr Ne Ste 552 Atlanta GA 30345-2844 | |
| (404) 850-9712 | |
| Not Available |
| Full Name | Magnolia Med Management, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2295 Parklake Dr Ne Ste 552, Atlanta, Georgia |
| Authorized Official Name and Position | Jeff Sanders (PSYCHIATRIST) |
| Authorized Official Contact | 4048509712 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Med Management, Llc 2295 Parklake Dr Ne Ste 552 Atlanta GA 30345-2844 Ph: (404) 850-9712 | Magnolia Med Management, Llc 2295 Parklake Dr Ne Ste 552 Atlanta GA 30345-2844 Ph: (404) 850-9712 |
| NPI Number | 1356803985 |
|---|---|
| Provider Enumeration Date | 04/02/2019 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 8921410010 |
|---|---|
| Medicare Enrollment ID | O20201214002855 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356803985 | NPI | - | NPPES |
| 1821124488 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jeff D Sanders |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821124488 PECOS PAC ID: 9234370958 Enrollment ID: I20130723000618 |
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