# MAGNOLIA CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EAST MS STATE HOSPITAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093038234
- **Authorized official:** MR. CHARLES CARLISLE MPPA (DIRECTOR)
- **Authorized official phone:** (601) 581-7836

## Contact information

- **Practice address:** 4555 HIGHLAND PARK DR, MERIDIAN, MS 39307-5429
- **Practice address phone:** (601) 481-1135
- **Practice address fax:** (601) 581-7676
- **Mailing address:** P O BOX 4128, WEST STATION, 4555 HIGHLAND PARK DRIVE, MERIDIAN,, MS 39304-4128
- **Mailing address phone:** (601) 481-1135
- **Mailing address fax:** (601) 581-7676

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 31 136 | MS | Yes |

## Other

- **Enumeration date:** 03/02/2010
- **Last updated:** 03/02/2010