Organization
MAGNOLIA PRIMARY CARE
Active
Parent organization
MAGNOLIA REGIONAL HEALTH CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
MAGNOLIA REGIONAL HEALTH CENTER
Authorized official
RONNY D. HUMES (CHIEF EXECUTIVE OFFICER)
(662) 293-7664
Entity
Organization
Contact information
Practice address
202 ALCORN DR, CORINTH, MS 38834-9701
(662) 287-4481
(662) 287-4368
Mailing address
401 ALCORN DR STE 2C, CORINTH, MS 38834-9073
(662) 293-7266
(662) 293-6255
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05252561
—
MS
Enumeration date
05/11/2017
Last updated
01/23/2019
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