Provider Demographics
NPI:1922844323
Name:MAGNOLIA MEDSPA HOLDINGS PLLC
Entity type:Organization
Organization Name:MAGNOLIA MEDSPA HOLDINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-482-3411
Mailing Address - Street 1:2111 KIRKWOOD BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1461
Mailing Address - Country:US
Mailing Address - Phone:817-329-0102
Mailing Address - Fax:
Practice Address - Street 1:2111 KIRKWOOD BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1461
Practice Address - Country:US
Practice Address - Phone:817-329-0102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty