Southern Magnolia Personal Care Home

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

442827106A Issued in GA

Legal business name

SOUTHERN MAGNOLIA PERSONAL CARE HOME

Practice address

405 Thompson St
Vidalia, GA 30474-3120

Phone

(912) 537-2379

Fax

(912) 537-7040

NPI assigned

Jan 27, 2015

Last updated

Jan 27, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Mae Lois Day

Title

Owner

Phone

(912) 537-2379

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422316800000",
    "number": "1427448679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 THOMPSON ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304743120",
            "telephone_number": "912-537-2379",
            "fax_number": "912-537-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 THOMPSON ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304743120",
            "telephone_number": "912-537-2379",
            "fax_number": "912-537-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAGNOLIA PERSONAL CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-27",
        "last_updated": "2015-01-27",
        "status": "A",
        "authorized_official_last_name": "DAY",
        "authorized_official_first_name": "MAE",
        "authorized_official_middle_name": "LOIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-537-2379",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "GA",
            "license": "442827106A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeastern Cardiology
• Southeastern Cardiovascular Img, Inc.
• Southern Chiro Vidalia, LLC
• Southern Choices LLC
• Southern Community Hospice, Inc. (Community Hospice)
• John V Spence, M.D.
• Charles M Spivey, MD
• John Casey Spivey, MD
• Carl Leland Stalvey, M.D.
• Kristin Nicole Stanford, PHARMD

• Point of Service in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Point of Service in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; 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.