Organization
MAGNOLIA BLOOMS PCH,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDY WAGES BALLARD (OWNER)
(678) 458-2011
Entity
Organization
Contact information
Practice address
1250 NICHOLSVILLE RD NW, MONROE, GA 30656-3469
(678) 458-2011
Mailing address
1250 NICHOLSVILLE RD NW, MONROE, GA 30656-3469
(678) 458-2011
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
147-01-013-1
GA
Other
Enumeration date
11/17/2008
Last updated
11/17/2008
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