NPIMap

Organization Active NPI

Magnolia ENT, LLC

  • Otolaryngology Physician
  • Peachtree City, GA
National Provider Identifier
1720828395
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
MAGNOLIA ENT, LLC
Practice address
1000 Commerce Dr Ste 200
Peachtree City, GA 30269-3520
Phone
(470) 489-0090
Fax
(470) 489-0090
NPI assigned
May 30, 2024
Last updated
Jun 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Dr. Nancy H Jennings, MD
Title
Partner
Phone
(678) 427-1499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X Primary

Addresses

Primary practice location

1000 Commerce Dr Ste 200
Peachtree City, GA 30269-3520

Mailing address

1000 Commerce Dr Ste 200
Peachtree City, GA 30269-3520
Phone (404) 725-8786

Other practice location 1

1015 Lafayette Pkwy Ste 130
LaGrange, GA 30241-3584
Phone (470) 489-0090

Other practice location 2

1365 Rock Quarry Rd Ste 300
Stockbridge, GA 30281-5024
Phone (470) 489-0090

Other practice location 3

20 Francis Way
Sharpsburg, GA 30277-3589
Phone (470) 489-0090

Other practice location 4

1595 Highway 34 E
Newnan, GA 30265-2353
Phone (470) 489-0090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240815002826 GA Part B Supplier - Clinic/Group Practice 3779021118 Receives reassigned benefits from 15 practitioners
Practice locations: Newnan, GA; Stockbridge, GA; Sharpsburg, GA; Peachtree City, GA; Lagrange, GA

National Provider Directory

National Provider Directory

Locations

20 Francis Way
Sharpsburg, GA 30277
Phone (470) 489-0090

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1717027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1720828395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 COMMERCE DR STE 200",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693520",
            "telephone_number": "404-725-8786",
            "fax_number": "770-615-5017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 COMMERCE DR STE 200",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693520",
            "telephone_number": "470-489-0090",
            "fax_number": "470-489-0090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1015 Lafayette Pkwy Ste 130",
            "address_purpose": "LOCATION",
            "city": "LaGrange",
            "state": "GA",
            "postal_code": "302413584",
            "country_code": "US",
            "telephone_number": "470-489-0090",
            "fax_number": "470-489-0090",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1365 Rock Quarry Rd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302815024",
            "country_code": "US",
            "telephone_number": "470-489-0090",
            "fax_number": "470-489-0090",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 Francis Way",
            "address_purpose": "LOCATION",
            "city": "Sharpsburg",
            "state": "GA",
            "postal_code": "302773589",
            "country_code": "US",
            "telephone_number": "470-489-0090",
            "fax_number": "470-489-0090",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1595 Highway 34 E",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302652353",
            "country_code": "US",
            "telephone_number": "470-489-0090",
            "fax_number": "470-489-0090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAGNOLIA ENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-30",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "678-427-1499",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.