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General NPI Number Information
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NPI Number | 1487508883
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MD PLLC
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 391 SOUTHCREST CIR STE 209
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6734
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Country | US
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Telephone | 662-208-6234
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Fax | 662-208-6234
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Provider Business Mailing Address
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Address Line | 391 SOUTHCREST CIR STE 209
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6734
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Country | US
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Telephone | 662-208-6234
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Fax | 662-208-6234
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Authorized Official
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Title or Position | OWNER
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Name | SRINIVASA JAMPANA
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Credential | MD
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Telephone | 662-208-6234
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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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