# MAGNOLIA SPECIALTY CLINIC

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

## Provider details

- **NPI number:** 1104464395
- **Authorized official:** MARC NAKAGAWA (CFO)
- **Authorized official phone:** (662) 293-7660

## Contact information

- **Practice address:** 3704 HIGHWAY 72 W, CORINTH, MS 38834-8556
- **Practice address phone:** (662) 665-8041
- **Practice address fax:** (662) 665-8049
- **Mailing address:** 401 ALCORN DR STE 2C, CORINTH, MS 38834-9073
- **Mailing address phone:** (662) 293-7618
- **Mailing address fax:** (662) 293-4358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 12/18/2019
- **Last updated:** 05/14/2021