Organization
MAGNOLIA FIREFLIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER PAINTER (SOLE PROPRIETOR)
(601) 543-9136
Entity
Organization
Contact information
Practice address
15 SAINT AUGUSTINE AVE, HATTIESBURG, MS 39402-6609
(601) 543-9136
Mailing address
15 SAINT AUGUSTINE AVE, HATTIESBURG, MS 39402-6609
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20678
MS
Other
Enumeration date
05/04/2011
Last updated
05/04/2011
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