NPIMap

Organization Active NPI

Magnolia Health Clinic

  • Primary Care Clinic/Center
  • Atlanta, GA
National Provider Identifier
1487047049
Registry record updated Mar 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
00222568 Issued in GA
Legal business name
MAGNOLIA HEALTH CLINIC
Practice address
3350 Northlake Pkwy NE
Suite B
Atlanta, GA 30345-2204
Phone
(770) 724-8093
NPI assigned
Mar 6, 2015
Organization subpart
Yes
Parent organization
MAGNOLIA BEHAVIORAL HEALTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2015

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

Authorized official

Name
Dr. Mira Iheme, PH.D., LPC
Title
President
Phone
(770) 724-8093

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 00222568 GA Primary

Addresses

Primary practice location

3350 Northlake Pkwy NE
Suite B
Atlanta, GA 30345-2204

Mailing address

3350 Northlake Pkwy NE
Suite B
Atlanta, GA 30345-2204
Phone (770) 724-8093

National Provider Directory

National Provider Directory
Tax ID family
Magnolia Behavioral Health Inc2 organizations share this tax ID, including this one
Part of
Magnolia Behavioral Health Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3350 Northlake Pkwy NE
Ste B
Atlanta, GA 30345
Phone (770) 724-8093

Ownership & related parties

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.

NPI Registry JSON

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

{
    "created_epoch": "1425600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425600000000",
    "number": "1487047049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 NORTHLAKE PKWY NE",
            "address_2": "SUITE B",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452204",
            "telephone_number": "770-724-8093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 NORTHLAKE PKWY NE",
            "address_2": "SUITE B",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452204",
            "telephone_number": "770-724-8093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA HEALTH CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAGNOLIA BEHAVIORAL HEALTH, INC.",
        "enumeration_date": "2015-03-06",
        "last_updated": "2015-03-06",
        "status": "A",
        "authorized_official_last_name": "IHEME",
        "authorized_official_first_name": "MIRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-724-8093",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LPC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "00222568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.