Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Magnolia Pediatrics LLC

Organization Pediatrics Physician · NPI 1356513964

Magnolia Pediatrics LLC is a Pediatrics Physician in Lake City, Florida. Licensed in Florida. Registered with an NPI since 2008.

Licensed in
FL
In the registry since
2008
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1140 SW Bascom Norris Dr Ste 104
Lake City, FL 32025-1329
Phone: (386) 719-6500
Fax: (386) 719-6503
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence ME72652 (FL)

Record details

NPI number1356513964
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Bilal Khodr — Provider · (386) 719-6500
NPI enumeratedMarch 24, 2008
Last updated in NPPESOctober 5, 2012
Mailing address1140 Sw Bascom Norris Dr Ste 104, Lake City, FL 32025-1329

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