Provider Demographics
NPI:1205692407
Name:MAGNOLIA FAMILY PRACTICE
Entity type:Organization
Organization Name:MAGNOLIA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MAGUIRE
Authorized Official - Last Name:GROFF
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:334-568-5025
Mailing Address - Street 1:1841 GLYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5584
Mailing Address - Country:US
Mailing Address - Phone:334-568-5025
Mailing Address - Fax:334-569-5021
Practice Address - Street 1:1841 GLYNWOOD DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5584
Practice Address - Country:US
Practice Address - Phone:334-568-5025
Practice Address - Fax:334-568-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty