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Organization
MAGNOLIA WOMAN'S CLINIC, P.A.
Active
Organization
MAGNOLIA WOMAN'S CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER RAY WOLFE M.D. (OWNER/PRESIDENT)
(601) 200-8201
Entity
Organization
Contact information
Practice address
970 LAKELAND DR, SUITE 43, JACKSON, MS 39216-4635
(601) 200-8201
Mailing address
970 LAKELAND DR, SUITE 43, JACKSON, MS 39216-4635
(601) 200-8201
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
11096
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00131201
—
MS
01
—
4224712
AETNA
—
01
—
428940305A
BLUE CROSS BLUE SHEILD
MS
01
—
7430106
UNITED HEALTH CARE
MS
Enumeration date
03/13/2008
Last updated
03/13/2008
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