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MAGNOLIA FUNCTIONAL MEDICINE, LLC
NPI 1952196826
General Practice in Charleston, SC

Active since April 11, 2025CLIA 42D2334869 · Waiver
1064 GARDNER RD STE 208, CHARLESTON, SC 29407(843) 501-2333 Get Directions Write a Review

NPPES record last updated: May 15, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 15, 2026, Apr 11, 2025 (2 updates tracked since 2025).

About Magnolia Functional Medicine, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAGNOLIA FUNCTIONAL MEDICINE, LLC (NPI 1952196826) is a healthcare organization registered as a general practice in Charleston, South Carolina and active in the NPI registry since April 2025. The organization holds a CLIA Waiver certificate valid through December 2, 2027 and lists Jessica Green, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1952196826
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameMAGNOLIA FUNCTIONAL MEDICINE, LLC
Location Address1064 GARDNER RD STE 208Charleston, SC 29407-1712
Mailing Address1064 Gardner Rd Ste 208Charleston, SC 29407-1712 · (843) 513-9577
Phone(843) 501-2333
Organization SubpartNo
Authorized OfficialJessica GreenPractice Manager · (843) 513-9577
Enumeration DateApril 11, 2025
Last NPPES UpdateMay 15, 20262 updates tracked since enumeration
NPPES CertifiedMay 15, 2026
✔ NPI 1952196826 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedNaturopathTaxonomy 175F00000X
Also ListedInternal Medicine · Endocrinology, Diabetes & MetabolismTaxonomy 207RE0101X
1064 GARDNER RD STE 208, Charleston, SC 29407
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 42D2334869

Magnolia Functional Medicine, LLC · Charleston, SC
Active · expires Dec 2, 2027
CLIA Number42D2334869
Laboratory TypePhysician Office
Certificate Effective DateDecember 3, 2025
Certificate Expiration DateDecember 2, 2027
Laboratory DirectorLashana Wilder
Laboratory Phone(843) 501-2333
Laboratory LocationMagnolia Functional Medicine, LLC1064 Gardner Road Suite 208, Charleston, SC 29407
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. LASHANA JONETTE WILDER P.A.
Physician Assistant
1064 GARDNER RD STE 208
CHARLESTON, SC 29407
Charleston County (843) 824-4786

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Magnolia Functional Medicine, LLC's NPI number?

The NPI number for Magnolia Functional Medicine, LLC is 1952196826. It was assigned to this organization in the NPPES registry on April 11, 2025.

Where is Magnolia Functional Medicine, LLC located?

Magnolia Functional Medicine, LLC is located at 1064 Gardner Rd Ste 208, Charleston, SC 29407. The listed phone number is (843) 501-2333.

What is Magnolia Functional Medicine, LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does Magnolia Functional Medicine, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 42D2334869) is associated with this NPI, valid through December 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Magnolia Functional Medicine, LLC was last updated on May 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.