Healthcare Provider Details

I. General information

NPI: 1386452878
Provider Name (Legal Business Name): MAGNOLIA WEIGHT LOSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BLUE MEADOW RD UNIT 101
BAY ST LOUIS MS
39520-2834
US

IV. Provider business mailing address

620 BLUE MEADOW RD UNIT 101
BAY ST LOUIS MS
39520-2834
US

V. Phone/Fax

Practice location:
  • Phone: 228-229-9038
  • Fax:
Mailing address:
  • Phone: 228-229-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS J TURFITT III
Title or Position: OWNER
Credential:
Phone: 228-229-9038