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General NPI Number Information
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NPI Number | 1386452878
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Entity Type | Organization
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Legal Business Name | MAGNOLIA WEIGHT LOSS LLC
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 620 BLUE MEADOW RD UNIT 101
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City | BAY ST LOUIS
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State | MS
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Zip | 39520-2834
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Country | US
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Telephone | 228-229-9038
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Fax |
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Provider Business Mailing Address
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Address Line | 620 BLUE MEADOW RD UNIT 101
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City | BAY ST LOUIS
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State | MS
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Zip | 39520-2834
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Country | US
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Telephone | 228-229-9038
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS J TURFITT III
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Credential |
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Telephone | 228-229-9038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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