Healthcare Provider Details

I. General information

NPI: 1104078328
Provider Name (Legal Business Name): MAGNOLIA REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ALCORN DR STE 1B
CORINTH MS
38834-9071
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 662-293-7390
  • Fax: 662-293-7399
Mailing address:
  • Phone: 662-293-1553
  • Fax: 662-293-7696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES HOBSON
Title or Position: CEO
Credential:
Phone: 662-293-7664