# MAGNOLIA FAMILY MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023228632
- **Authorized official:** JOHN B KAYOMA MD (OWNER)
- **Authorized official phone:** (662) 332-2077

## Contact information

- **Practice address:** 1660 S COLORADO ST, GREENVILLE, MS 38703-7216
- **Practice address phone:** (662) 332-2077
- **Practice address fax:** (662) 332-0790
- **Mailing address:** 1660 S COLORADO ST, GREENVILLE, MS 38703-7216
- **Mailing address phone:** (662) 332-2077
- **Mailing address fax:** (662) 332-0790

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 17503 | MS | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 12/31/2007