Organization
MAGNOLIA CLINIC
Active
Other names
EAST MS STATE HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES CARLISLE MPPA (DIRECTOR)
(601) 581-7836
Entity
Organization
Contact information
Practice address
4555 HIGHLAND PARK DR, MERIDIAN, MS 39307-5429
(601) 481-1135
(601) 581-7676
Mailing address
P O BOX 4128, WEST STATION, 4555 HIGHLAND PARK DRIVE, MERIDIAN,, MS 39304-4128
(601) 481-1135
(601) 581-7676
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
31 136
MS
Other
Enumeration date
03/02/2010
Last updated
03/02/2010
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