Organization
MAGNOLIA MANOR OF TUPELO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DONNA PHARR (EXECUTIVE DIRECTOR)
(662) 842-6776
Entity
Organization
Contact information
Practice address
1514 COUNTY ROAD 41, TUPELO, MS 38801-0681
(662) 842-6776
(662) 842-6512
Mailing address
1514 COUNTY ROAD 41, TUPELO, MS 38801-0681
(662) 842-6776
(662) 842-6512
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
1000
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03083202
—
MS
Enumeration date
12/18/2007
Last updated
12/18/2007
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