# MAGNOLIA MEDICAL CLINIC LLC

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

## Provider details

- **NPI number:** 1356179295
- **Authorized official:** DR. KRISTYN BUMPERS PHARM. D. (PHARMACIST)
- **Authorized official phone:** (601) 441-4400

## Contact information

- **Practice address:** 431 BROAD ST, COLUMBIA, MS 39429-3056
- **Practice address phone:** (601) 736-8212
- **Mailing address:** 79 HIGHPOINTE DR, HATTIESBURG, MS 39402-9536

## Taxonomy

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

## Other

- **Enumeration date:** 07/23/2024
- **Last updated:** 07/23/2024