Provider Demographics
NPI:1811507247
Name:MAGNOLIA MEDICAL CENTER LLC
Entity type:Organization
Organization Name:MAGNOLIA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:GEBHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-241-2050
Mailing Address - Street 1:237 N STEEL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-8129
Mailing Address - Country:US
Mailing Address - Phone:770-241-2050
Mailing Address - Fax:
Practice Address - Street 1:101 CHASE CT NW STE B
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7188
Practice Address - Country:US
Practice Address - Phone:478-202-8794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty