Organization
MAGNOLIA PSYCHIATRIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TRACEY L MATTINA (MANAGER)
(228) 818-0563
Entity
Organization
Contact information
Practice address
2124 GOVERNMENT ST, OCEAN SPRINGS, MS 39564-3937
(228) 818-9050
(228) 872-6300
Mailing address
2124 GOVERNMENT ST, OCEAN SPRINGS, MS 39564-3937
(228) 818-9050
(228) 872-6300
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
18977
MS
Other
Enumeration date
09/10/2007
Last updated
09/10/2007
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