Provider Demographics
NPI:1609598424
Name:MAGNOLIA HEALTHCARE & AESTHETICS, PLLC
Entity Type:Organization
Organization Name:MAGNOLIA HEALTHCARE & AESTHETICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:POUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:919-227-6434
Mailing Address - Street 1:34 OLEANDER DR STE 107
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-4599
Mailing Address - Country:US
Mailing Address - Phone:919-227-6434
Mailing Address - Fax:
Practice Address - Street 1:34 OLEANDER DR STE 107
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-4599
Practice Address - Country:US
Practice Address - Phone:919-227-6434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty