Magnolia Functional Medicine, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MAGNOLIA FUNCTIONAL MEDICINE, LLC

Practice address

1064 Gardner Rd Ste 208
Charleston, SC 29407-1712

Phone

(843) 501-2333

NPI assigned

Apr 11, 2025

Organization subpart

No

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

Authorized official

Name

Jessica Green

Title

Practice Manager

Phone

(843) 513-9577

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lashana Jonette Wilder, P.A.

  • Physician Assistant
  • Charleston, SC
  • NPI 1396927125
  Medicare reassignment NPD
• Dushyant Viswanathan, M.D.

  • Internal Medicine Physician
  • Woodland Hills, CA
  • NPI 1285897421

  Multi-Specialty, SC

  Medicare reassignment NPD

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

{
    "created_epoch": "1744329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778803200000",
    "number": "1952196826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1064 GARDNER RD STE 208",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294071712",
            "telephone_number": "843-513-9577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1064 GARDNER RD STE 208",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294071712",
            "telephone_number": "843-501-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA FUNCTIONAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-11",
        "last_updated": "2026-05-15",
        "certification_date": "2026-05-15",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "843-513-9577"
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Naturopath",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha Faris Magill, RPH
• David Magno-Padron, M.D.,
• Daniel Magno, PHARMD
• Magnolia Center Inc
• Magnolia Dermatology, LLC
• Magnolia Speech & Feeding Therapy LLC
• Magnum Health, Inc
• Laura Magnuson, M.D.
• George Nathaniel Magrath III, MD
• Sydney Magrath, PHARMD

• General Practice Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• General Practice Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.