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Organization

MAGNOLIA WOMAN'S CLINIC, P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WALTER RAY WOLFE M.D. (OWNER/PRESIDENT)
(601) 200-8201
Entity
Organization

Contact information

Practice address
970 LAKELAND DR, SUITE 43, JACKSON, MS 39216-4635
(601) 200-8201
Mailing address
970 LAKELAND DR, SUITE 43, JACKSON, MS 39216-4635
(601) 200-8201

Taxonomy

Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
11096
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00131201
MS
01
4224712
AETNA
01
428940305A
BLUE CROSS BLUE SHEILD
MS
01
7430106
UNITED HEALTH CARE
MS
Enumeration date
03/13/2008
Last updated
03/13/2008
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