Organization
MAGNOLIA ORTHOPAEDICS & SPORTS MEDICINE, P.A.
Active
Organization
MAGNOLIA ORTHOPAEDICS & SPORTS MEDICINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLIE GOOCH (OFFICE MANAGER)
(662) 286-6369
Entity
Organization
Contact information
Practice address
611 ALCORN DR, SUITE 100, CORINTH, MS 38834-9321
(662) 286-6369
(662) 286-2768
Mailing address
611 ALCORN DR, SUITE 100, CORINTH, MS 38834-9321
(662) 286-6369
(662) 286-2768
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013928
—
MS
Enumeration date
07/22/2006
Last updated
08/15/2013
Update your record
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