# MAGNOLIA FAMILY MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639319213
- **Authorized official:** DR. RICHARD ADAM GUTSIN D.O. (OWNER)
- **Authorized official phone:** (910) 796-3212

## Contact information

- **Practice address:** 3720 SHIPYARD BLVD, WILMINGTON, NC 28403-6147
- **Practice address phone:** (910) 796-3212
- **Practice address fax:** (910) 796-3216
- **Mailing address:** 3720 SHIPYARD BLVD, WILMINGTON, NC 28403-6147
- **Mailing address phone:** (910) 796-3212
- **Mailing address fax:** (910) 796-3216

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 9500364 | NC | Yes |

## Other

- **Enumeration date:** 02/23/2009
- **Last updated:** 04/29/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7937920 | — | NC |