# MAGNOLIA FAMILY MEDICINE, PLLC

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

## Provider details

- **NPI number:** 1699787515
- **Authorized official:** LARRY LEE MONTGOMERY M.D. (OWNER)
- **Authorized official phone:** (601) 684-8800

## Contact information

- **Practice address:** 415 MARION AVE, SUITE 399, MCCOMB, MS 39648-2709
- **Practice address phone:** (601) 684-8800
- **Practice address fax:** (601) 914-2937
- **Mailing address:** 1074 BRANDON DR, MCCOMB, MS 39648-6130
- **Mailing address phone:** (601) 684-1633
- **Mailing address fax:** (601) 914-2937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 16277 | MS | Yes |

## Other

- **Enumeration date:** 08/12/2006
- **Last updated:** 03/07/2023