Organization
MAGNOLIA INTERNAL MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN L. SUMMERS M,D, (PRESIDENT)
(601) 933-9696
Entity
Organization
Contact information
Practice address
5 RIVER BEND PL, SUITE C, FLOWOOD, MS 39232-7618
(601) 933-9696
Mailing address
PO BOX 321411, FLOWOOD, MS 39232-1411
(601) 933-9696
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16638
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06923312
—
MS
Enumeration date
08/21/2006
Last updated
07/13/2007
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