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MAGNOLIA PEDIATRIC CLINIC NPI 1104078328


NPI Information

NPI: 1104078328
Provider Name: MAGNOLIA PEDIATRIC CLINIC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 25D1091410

Address:
401 ALCORN DRIVE
1 B
CORINTH, MS
ZIP 38834
Phone: (662) 293-7390
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MAGNOLIA PEDIATRIC CLINIC is a pediatrics in Corinth, MS. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. MAGNOLIA PEDIATRIC CLINIC NPI is 1104078328. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

401 ALCORN DRIVE
1 B
CORINTH, MS
ZIP 38834-323
Phone: (662) 293-7390
Fax: (662) 293-7399

The provider's authorized official is Howard Nelson .
The authorized official title is Vp Physician Services and has the following contact phone number (662) 293-7618.

The CLIA number assigned to this NPI record is 25D1091410 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/21/2008 and was last updated on 1/25/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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