Healthcare Provider Details

I. General information

NPI: 1407188501
Provider Name (Legal Business Name): MAGNOLIA REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCRON DRIVE
CORINTH MS
38834
US

IV. Provider business mailing address

611 ALCRON DRIVE
CORINTH MS
38834
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1000
  • Fax: 662-293-4201
Mailing address:
  • Phone: 662-293-1000
  • Fax: 662-293-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. RONNY HUMES
Title or Position: CEO
Credential:
Phone: 662-293-7661