Organization
HEALTHTRUST MAGNOLIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY H GENDUSA (MANAGING MEMBER)
(601) 606-6366
Entity
Organization
Contact information
Practice address
203 S 40TH AVE STE B, HATTIESBURG, MS 39402-1604
(601) 606-6366
Mailing address
PO BOX 17168, HATTIESBURG, MS 39404-7168
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
11/09/2017
Last updated
11/09/2017
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