# MAGNOLIA PEDIATRICS

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

## Provider details

- **NPI number:** 1467618298
- **Authorized official:** DR. STEPHEN ALEXANDER CORONTZES M.D. (PRESIDENT)
- **Authorized official phone:** (843) 347-9099

## Contact information

- **Practice address:** 600 SINGLETON RIDGE RD, CONWAY, SC 29526-9154
- **Practice address phone:** (843) 347-9099
- **Practice address fax:** (866) 632-2923
- **Mailing address:** 600 SINGLETON RIDGE RD, CONWAY, SC 29526-9154
- **Mailing address phone:** (843) 347-9099
- **Mailing address fax:** (843) 347-9029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 13931 | SC | Yes |

## Other

- **Enumeration date:** 07/31/2008
- **Last updated:** 02/08/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 139317 | — | SC |
| 05 | — | 327877 | — | SC |
| 05 | — | GP2059 | — | SC |