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Organization

MAGNOLIA PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. STEPHEN ALEXANDER CORONTZES M.D. (PRESIDENT)
(843) 347-9099
Entity
Organization

Contact information

Practice address
600 SINGLETON RIDGE RD, CONWAY, SC 29526-9154
(843) 347-9099
(866) 632-2923
Mailing address
600 SINGLETON RIDGE RD, CONWAY, SC 29526-9154
(843) 347-9099
(843) 347-9029

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
13931
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
139317
SC
05
327877
SC
05
GP2059
SC
Enumeration date
07/31/2008
Last updated
02/08/2013
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