Healthcare Provider Details

I. General information

NPI: 1457547838
Provider Name (Legal Business Name): MAGNOLIA HOSPITALIST GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DRIVE
CORINTH MS
38834-9323
US

IV. Provider business mailing address

P.O. BOX 2040
CORINTH MS
38835-2040
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1000
  • Fax: 662-293-4323
Mailing address:
  • Phone: 662-293-1000
  • Fax: 662-293-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNY D. HUMES
Title or Position: CEO/ME
Credential:
Phone: 662-293-7664