=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578512919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMAGING ASSOCIATES OF NORTH MISSISSIPPI MAGNOLIA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 03/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 ALCORN DR RADIOLOGY DEPT.
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38834-9368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-293-1475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 499 GLOSTER CREEK VLG SUITE J-7
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-4600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-821-1831
-----------------------------------------------------
Fax | 662-821-1815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. CHARLES MICHAEL CURRIE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 662-821-1831
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------