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General NPI Number Information
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NPI Number | 1386073294
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Entity Type | Organization
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Legal Business Name | MAGNOLIA IMAGING ASSOCIATES, PLLC
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 611 ALCORN DR
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City | CORINTH
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State | MS
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Zip | 38834-9321
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Country | US
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Telephone | 662-293-1477
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9186
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City | LONGVIEW
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State | TX
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Zip | 75608-9186
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Country | US
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Telephone | 662-293-1477
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. R. GRAHAM SEXTON
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Credential | M.D.
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Telephone | 901-626-0296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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