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General NPI Number Information
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NPI Number | 1225534530
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Entity Type | Organization
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Legal Business Name | MAGNOLIA ALLERGY AND SKIN CARE
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 102 E LEAKE ST
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City | CLINTON
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State | MS
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Zip | 39056-4204
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Country | US
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Telephone | 601-519-9562
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Fax |
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Provider Business Mailing Address
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Address Line | 124 HEIGHTS DR
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City | CLINTON
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State | MS
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Zip | 39056-6602
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Country | US
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Telephone | 601-519-9562
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LAN ZHOU
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Credential | MD PHD
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Telephone | 601-519-9562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | 22223
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License Number State | MS
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