Organization
MAGNOLIA FUNCTIONAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA GREEN (PRACTICE MANAGER)
(843) 513-9577
Entity
Organization
Contact information
Practice address
1064 GARDNER RD STE 208, CHARLESTON, SC 29407-1712
(843) 501-2333
Mailing address
1064 GARDNER RD STE 208, CHARLESTON, SC 29407-1712
(843) 513-9577
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
04/11/2025
Last updated
05/15/2026
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