Healthcare Provider Details

I. General information

NPI: 1104945096
Provider Name (Legal Business Name): MAGEE BENEVOLENT ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 2ND SE ST
MAGEE MS
39111
US

IV. Provider business mailing address

300 THIRD AVENUE SOUTH EAST
MAGEE MS
39111
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-7339
  • Fax: 601-849-7221
Mailing address:
  • Phone: 601-849-7339
  • Fax: 601-849-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8656
License Number StateMS

VIII. Authorized Official

Name: DR. MICHAEL S WARD
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 601-849-7339