Organization
MAGNOLIA FAMILY MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY LEE MONTGOMERY M.D. (OWNER)
(601) 684-8800
Entity
Organization
Contact information
Practice address
415 MARION AVE, SUITE 399, MCCOMB, MS 39648-2709
(601) 684-8800
(601) 914-2937
Mailing address
1074 BRANDON DR, MCCOMB, MS 39648-6130
(601) 684-1633
(601) 914-2937
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16277
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120513
—
MS
01
—
16277
STATE MEDICAL LICENSE
MS
Enumeration date
08/12/2006
Last updated
03/07/2023
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