Healthcare Provider Details

I. General information

NPI: 1164333860
Provider Name (Legal Business Name): THE MAGNOLIA FAMILY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E LINCOLN RD NE STE H
BROOKHAVEN MS
39601-8757
US

IV. Provider business mailing address

19 E LINCOLN RD NE STE H
BROOKHAVEN MS
39601-8757
US

V. Phone/Fax

Practice location:
  • Phone: 601-835-1882
  • Fax:
Mailing address:
  • Phone: 601-835-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY BURAGE
Title or Position: OWNER/PROVIDER
Credential: FNP
Phone: 601-748-0112