MEDICARE: MAGNOLIA ANESTHESIOLOGY ASSOCIATES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780665547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA ANESTHESIOLOGY ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 24023
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39225-4023
Country	:	US
Telephone Number	:	622-662-6650
Fax Number	:	622-665-0458

Provider Business Practice Location Address
First Line	:	401 ALCORN DR
Second Line	:
City	:	CORINTH
State	:	MS
Zip	:	38834-9067
Country	:	US
Telephone Number	:	662-665-0457
Fax Number	:	662-665-0458

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MISTY STRICKLAND
Credential	:
Telephone Number	:	662-665-0457

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	08/22/2020

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