Organization
MAGNOLIA GROVE HEALTHCARE
Active
Organization
MAGNOLIA GROVE HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY DECENA (OFFICE MANAGER)
(228) 863-4000
Entity
Organization
Contact information
Practice address
4333 15TH ST STE A, GULFPORT, MS 39501-2525
(228) 863-4000
(228) 863-4003
Mailing address
PO BOX 1040, GULFPORT, MS 39502-1040
(228) 863-4000
(228) 863-4003
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
12792
MS
Other
Enumeration date
08/16/2007
Last updated
08/16/2007
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