Organization
MAGNOLIA MIDLANDS PAIN MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MANDY BURKE (OFFICE MANAGER)
(912) 530-7516
Entity
Organization
Contact information
Practice address
186 S. MACON ST., JESUP, GA 31545-1117
(912) 530-7516
(912) 530-7517
Mailing address
186 S. MACON STREET, JESUP, GA 31545-1117
(912) 530-7516
(912) 530-7517
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
062371
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166390878A
—
GA
Enumeration date
06/22/2009
Last updated
11/05/2012
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