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General NPI Number Information
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NPI Number | 1821257767
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MEDICAL CLINIC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 502 ALCORN DRIVE
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City | CORINTH
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State | MS
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Zip | 38834-9323
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Country | US
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Telephone | 662-287-5216
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Fax | 662-287-8406
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Provider Business Mailing Address
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Address Line | P.O. BOX 2040
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City | CORINTH
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State | MS
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Zip | 38835-2040
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Country | US
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Telephone | 662-287-5216
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Fax | 662-287-8406
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Authorized Official
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Title or Position | CEO/ME
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Name | MR. RONNY D. HUMES
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Credential |
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Telephone | 662-293-7664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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