Organization
MAGNOLIA FOOT CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT SETH CROCKETT DPM (PRESIDENT)
(601) 934-8921
Entity
Organization
Contact information
Practice address
2310 4TH ST, SUITE A, MERIDIAN, MS 39301-5819
(601) 286-3745
Mailing address
2310 4TH ST, SUITE A, MERIDIAN, MS 39301-5819
(601) 286-3745
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
80193
MS
Other
Enumeration date
01/11/2011
Last updated
07/25/2012
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