Healthcare Provider Details

I. General information

NPI: 1265319453
Provider Name (Legal Business Name): MAGNOLIA REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ALCORN DR STE 2D
CORINTH MS
38834-9076
US

IV. Provider business mailing address

401 ALCORN DR STE 2C
CORINTH MS
38834-9073
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1288
  • Fax:
Mailing address:
  • Phone: 662-293-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANNON PALMER
Title or Position: FINANCIAL ANALYST
Credential:
Phone: 662-293-1288