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Organization
MAGNOLIA SPECIALTY CLINIC
Active
Organization
MAGNOLIA SPECIALTY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC NAKAGAWA (CFO)
(662) 293-7660
Entity
Organization
Contact information
Practice address
3704 HIGHWAY 72 W, CORINTH, MS 38834-8556
(662) 665-8041
(662) 665-8049
Mailing address
401 ALCORN DR STE 2C, CORINTH, MS 38834-9073
(662) 293-7618
(662) 293-4358
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/18/2019
Last updated
05/14/2021
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