Healthcare Provider Details

I. General information

NPI: 1225157258
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: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 MAGNOLIA DR
RALEIGH MS
39153-6016
US

IV. Provider business mailing address

234 MAGNOLIA DR
RALEIGH MS
39153-6016
US

V. Phone/Fax

Practice location:
  • Phone: 601-782-9797
  • Fax: 601-782-9790
Mailing address:
  • Phone: 601-782-9797
  • Fax: 601-782-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR764114
License Number StateMS

VIII. Authorized Official

Name: MS. SHARON L SCRUGGS
Title or Position: FAMILY NURSE PRACTIONER
Credential: FNP
Phone: 601-782-9797