# MAGNOLIA FOOT CLINIC LLC

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

## Provider details

- **NPI number:** 1699070326
- **Authorized official:** DR. ROBERT SETH CROCKETT DPM (PRESIDENT)
- **Authorized official phone:** (601) 934-8921

## Contact information

- **Practice address:** 2310 4TH ST, SUITE A, MERIDIAN, MS 39301-5819
- **Practice address phone:** (601) 286-3745
- **Mailing address:** 2310 4TH ST, SUITE A, MERIDIAN, MS 39301-5819
- **Mailing address phone:** (601) 286-3745

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 80193 | MS | Yes |

## Other

- **Enumeration date:** 01/11/2011
- **Last updated:** 07/25/2012