| Magnolia Medical Center Llc | |
|
101 Chase Ct Nw Ste B Milledgeville GA 31061-7188 | |
| (478) 202-8794 | |
| Not Available |
| Full Name | Magnolia Medical Center Llc |
|---|---|
| Speciality | General Practice |
| Location | 101 Chase Ct Nw Ste B, Milledgeville, Georgia |
| Authorized Official Name and Position | Alexander Karl Gebhardt (OWNER) |
| Authorized Official Contact | 7702412050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Medical Center Llc 237 N Steel Bridge Rd Eatonton GA 31024-8129 Ph: (770) 241-2050 | Magnolia Medical Center Llc 101 Chase Ct Nw Ste B Milledgeville GA 31061-7188 Ph: (478) 202-8794 |
| NPI Number | 1811507247 |
|---|---|
| Provider Enumeration Date | 07/31/2020 |
| Last Update Date | 08/05/2020 |
| Medicare PECOS PAC ID | 2769893254 |
|---|---|
| Medicare Enrollment ID | O20201207000276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811507247 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Raymond E Easley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255323655 PECOS PAC ID: 7517144504 Enrollment ID: I20110531000110 |
| Provider Name | Jamie Nicole Mauney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679000459 PECOS PAC ID: 5890066500 Enrollment ID: I20170728002630 |
| Provider Name | Alexander Gebhardt |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1184770620 PECOS PAC ID: 5698945624 Enrollment ID: I20201207000508 |
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