# HEALTHTRUST MAGNOLIA, LLC

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

## Provider details

- **NPI number:** 1144733361
- **Authorized official:** SHELLEY H GENDUSA (MANAGING MEMBER)
- **Authorized official phone:** (601) 606-6366

## Contact information

- **Practice address:** 203 S 40TH AVE STE B, HATTIESBURG, MS 39402-1604
- **Practice address phone:** (601) 606-6366
- **Mailing address:** PO BOX 17168, HATTIESBURG, MS 39404-7168

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/09/2017
- **Last updated:** 11/09/2017