Provider Demographics
NPI:1760066286
Name:MAGNOLIA FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:MAGNOLIA FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:RAHMAN
Authorized Official - Last Name:BROWNLIE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:865-300-8400
Mailing Address - Street 1:116 S GAY ST APT 505
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37902-4002
Mailing Address - Country:US
Mailing Address - Phone:865-300-8400
Mailing Address - Fax:
Practice Address - Street 1:6336 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-5938
Practice Address - Country:US
Practice Address - Phone:865-888-0857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care