Organization
MAGNOLIA EAR NOSE & THROAT
Active
Parent organization
MAGNOLIA REGIONAL HEALTH CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
MAGNOLIA REGIONAL HEALTH CENTER
Authorized official
RONNY HUMES (CEO)
(662) 293-7664
Entity
Organization
Contact information
Practice address
401 ALCORN DR, SUITE 2 D, CORINTH, MS 38834
(662) 293-1565
(662) 293-4204
Mailing address
401 ALCORN DR STE 2C, CORINTH, MS 38834-9073
(662) 293-7266
(662) 293-6255
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07633259
—
MS
01
—
583312
MS MEDICARE
MS
Enumeration date
02/07/2017
Last updated
07/18/2018
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