Provider Demographics
NPI:1659135739
Name:MAGNOLIA MEDICAL MARKETING DBA MAGNOLIA WELLNESS
Entity Type:Organization
Organization Name:MAGNOLIA MEDICAL MARKETING DBA MAGNOLIA WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:NESS
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-283-8172
Mailing Address - Street 1:153 TUPELO TRL
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-3673
Mailing Address - Country:US
Mailing Address - Phone:252-283-8172
Mailing Address - Fax:252-283-8174
Practice Address - Street 1:108 MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-6704
Practice Address - Country:US
Practice Address - Phone:252-283-8172
Practice Address - Fax:252-283-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty