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General NPI Number Information
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NPI Number | 1073471561
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MEDICAL INTERNAL MEDICINE INC
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 7591 FERN AVE STE 1401
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City | SHREVEPORT
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State | LA
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Zip | 71105-5747
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Country | US
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Telephone | 318-208-1804
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Fax | 318-203-5145
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Provider Business Mailing Address
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Address Line | 7591 FERN AVE STE 1401
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City | SHREVEPORT
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State | LA
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Zip | 71105-5747
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Country | US
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Telephone | 318-208-1804
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Fax | 318-203-5145
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | DR. CODY TINGLE
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Credential | MD
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Telephone | 318-208-1804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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