# MAGNOLIA MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1801340856
- **Authorized official:** DR. JUSTIN LANCE (DOCTOR/OWNER)
- **Authorized official phone:** (478) 453-2341

## Contact information

- **Practice address:** 946 HARMONY RD, EATONTON, GA 31024-5877
- **Practice address phone:** (706) 991-5320
- **Practice address fax:** (866) 720-5313
- **Mailing address:** 946 HARMONY RD STE B, EATONTON, GA 31024-5877
- **Mailing address phone:** (706) 991-5320
- **Mailing address fax:** (866) 720-5313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | ME53031 | GA | Yes |

## Other

- **Enumeration date:** 08/08/2016
- **Last updated:** 09/19/2024