Organization
SWEET MAGNOLIA MOON, A SLEEP CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERTHA J BLANCHARD M.D. (OWNER)
(601) 268-5222
Entity
Organization
Contact information
Practice address
6026 U S HIGHWAY 98, SUITE 3, HATTIESBURG, MS 39402-8861
(601) 268-5222
(601) 296-3508
Mailing address
6026 U S HIGHWAY 98, SUITE 3, HATTIESBURG, MS 39402-8861
(601) 268-5222
(601) 296-3508
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Enumeration date
11/30/2007
Last updated
11/30/2007
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