Provider Demographics
NPI:1780013292
Name:MAGNOLIA WOMEN'S HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MAGNOLIA WOMEN'S HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUSSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-243-9299
Mailing Address - Street 1:PO BOX 1640
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1640
Mailing Address - Country:US
Mailing Address - Phone:912-243-9299
Mailing Address - Fax:912-243-9298
Practice Address - Street 1:1555 BRAMPTON AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0856
Practice Address - Country:US
Practice Address - Phone:912-243-9299
Practice Address - Fax:912-243-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070231207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty