Provider Demographics
NPI:1689323776
Name:MAGNOLIA FAMILY MEDICINE AND WELLNESS
Entity Type:Organization
Organization Name:MAGNOLIA FAMILY MEDICINE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:STREICHER
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-212-1479
Mailing Address - Street 1:1344 MCBRIDES BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BEECHGROVE
Mailing Address - State:TN
Mailing Address - Zip Code:37018-3718
Mailing Address - Country:US
Mailing Address - Phone:931-212-1479
Mailing Address - Fax:
Practice Address - Street 1:1402 WILLOW DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2438
Practice Address - Country:US
Practice Address - Phone:931-450-1000
Practice Address - Fax:931-450-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care