Healthcare Provider Details

I. General information

NPI: 1780665547
Provider Name (Legal Business Name): MAGNOLIA ANESTHESIOLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ALCORN DR
CORINTH MS
38834-9067
US

IV. Provider business mailing address

PO BOX 24023
JACKSON MS
39225-4023
US

V. Phone/Fax

Practice location:
  • Phone: 662-665-0457
  • Fax: 662-665-0458
Mailing address:
  • Phone: 622-662-6650
  • Fax: 622-665-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MISTY STRICKLAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-665-0457