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General NPI Number Information
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NPI Number | 1891988788
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Entity Type | Organization
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Legal Business Name | MAGNOLIA STATE FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 1009 CITY AVE N STE B
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City | RIPLEY
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State | MS
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Zip | 38663-1414
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Country | US
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Telephone | 662-993-9458
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Fax | 662-993-9459
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Provider Business Mailing Address
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Address Line | 1009 B CITY AVENUE NORTH SUITE B
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City | RIPLEY
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State | MS
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Zip | 38663
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Country | US
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Telephone | 662-993-9458
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Fax | 662-993-9459
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. CHRISTOPHER J.M. CUMMINS, MD
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Credential | MD
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Telephone | 662-993-9458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 19838
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License Number State | MS
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