Organization
MAGNOLIA PROFESSIONAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON COLEY (EXECUTIVE DIRECTOR PHYSICIAN SERVIC)
(662) 293-7678
Entity
Organization
Contact information
Practice address
703 ALCORN DRIVE, 109, CORINTH, MS 38834-9323
(662) 286-2522
(662) 293-4288
Mailing address
P.O. BOX 2040, CORINTH, MS 38835-2040
(662) 286-2522
(662) 293-4288
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05323894
—
MS
Enumeration date
07/22/2006
Last updated
05/14/2021
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