Magnolia Manor Incorporated

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

Legal business name

MAGNOLIA MANOR INCORPORATED

Practice address

2001 S Lee St
Americus, GA 31709-4715

Phone

(229) 924-9352

NPI assigned

Jun 27, 2007

Organization subpart

Yes

Parent organization

MAGNOLIA MANOR INCORPORATEDAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jerry Vick

Title

VP Finance

Phone

(229) 924-9352

Specialties & licenses 2

Addresses

Other identifiers 1

Part of

Magnolia Manor Pharmacy

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Georgia Pharmacy Ventures LLC

  • Long Term Care Pharmacy
  • Hawkinsville, GA
  • NPI 1497927321

  Member Of

  NPD member

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Magnolia Manor, Inc.

  • Skilled Nursing Facility
  • Americus, GA
  • NPI 1588647754
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236816000000",
    "number": "1326244120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S LEE ST",
            "city": "AMERICUS",
            "state": "GA",
            "postal_code": "317094715",
            "telephone_number": "229-924-9352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S LEE ST",
            "city": "AMERICUS",
            "state": "GA",
            "postal_code": "317094715",
            "telephone_number": "229-924-9352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MANOR INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAGNOLIA MANOR INCORPORATED",
        "enumeration_date": "2007-06-27",
        "last_updated": "2009-03-12",
        "status": "A",
        "authorized_official_last_name": "VICK",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "229-924-9352"
    },
    "taxonomies": [
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00040785C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Louis a. Riccardi Ddspc
• Joshua Phillip Lydic, MSW
• Michael Christopher Lytle, PHARMD
• Makayla Mack
• Nelson Tan Madrazo, M.D.
• Magnolia Manor Pharmacy
• Magnolia Manor, Inc.
• Shyquanda Mahome
• Carswella Benita Major, LICENSE PRACTICAL NU
• Shontasha Manghram, MSW

• Parenteral & Enteral Nutrition Supplies (DME) in Americus, GA
• Providers in Americus, GA by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.