MAGNOLIA SPECIALTY CLINIC (NPI# 1104464395) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104464395 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA SPECIALTY CLINIC |
| Practice Address |
3704 Highway 72 W Corinth MS 38834-8556 |
| Mailing Address |
401 Alcorn Dr Ste 2c Corinth MS 38834-9073 |
| Practice Telephone | 6626658041 |
| Practice Fax Number | 6626658049 |
| Mailing Telephone | 6622937618 |
| Mailing Fax Number | 6622934358 |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2019-12-18 |
| Authorized Official Name | MARC NAKAGAWA (CFO) |
| Authorized Official Telephone | 6622937660 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881959401 | Magnolia Specialty Clinic | Psychiatry & Neurology | 3704 Hwy. 72 West, Corinth, MS 38834-8556 | 2012-07-10 |
| Street Address |
3704 HIGHWAY 72 W |
| City | CORINTH |
| State | MS |
| Zip Code | 38834-8556 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508208992 | Mary Elizabeth Lindsey | Internal Medicine | 3704 Highway 72 W, Corinth, MS 38834-8556 | 2013-07-25 |
| 1639719032 | Holly Pettey | Registered Nurse | 3704 Highway 72 W, Corinth, MS 38834-8556 | 2020-01-14 |
| 1548706203 | Magnolia Nephrology Clinic | Internal Medicine | 3704 Highway 72 W, Corinth, MS 38834-8556 | 2017-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477176824 | Crystalcare | Clinic/Center | 3124 N Shiloh Road, Corinth, MS 38834 | 2020-05-20 |
| 1962046680 | Wanda Lee Kilpatrick | Technician | 1206 Breckenridge St., Corinth, MS 38834 | 2019-11-06 |
| 1215595756 | Alanna Nunez Heflin | Dentist | 3127 E Shiloh Rd, Corinth, MS 38834 | 2019-05-30 |
| 1629530795 | A Port In The Storm (apits) | Clinic/Center | 102 N. Cass Street, Suite B, Corinth, MS 38834 | 2019-04-05 |
| 1538654199 | Jerry Wayne Latch | Durable Medical Equipment & Medical Supplies | 206 N Fillmore St, Corinth, MS 38834 | 2018-06-26 |
| 1194215681 | Brooks Medical Clinic | Clinic/Center | 2113 South Tate Street, Corinth, MS 38834 | 2018-05-10 |
| 1164938650 | Pediatric Dentistry of Corinth | Dentist | 1500 N Harper Rd #5, Pediatric Dentistry of Corinth, Corinth, MS 38834 | 2017-12-19 |
| 1467964536 | King Speech-language Therapy, LLC | Speech-Language Pathologist | 2203 Hwy 72 East, Corinth, MS 38834 | 2017-10-30 |
| 1841669728 | Glenda Gatlin | Social Worker | 14 Cr 305, Corinth, MS 38834 | 2015-09-21 |
| 1649646555 | Amanda Word | Social Worker | 303 North Madison Street, Corinth, MS 38834 | 2015-08-14 |
| Find all providers in zip 38834 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841761129 | Dcgm, Inc | Internal Medicine | 1040 River Oaks Dr Ste 302, Flowood, MS 39232-9575 | 2018-12-11 |
| 1669727228 | Farah Naz Mushtaq | Internal Medicine | 5909 U S Highway 49 Ste 30, Hattiesburg, MS 39402-2860 | 2012-07-19 |
| 1649404435 | Memorial Hospital At Gulfport | Internal Medicine | 970 Tommy Munro Dr, Biloxi, MS 39532-2130 | 2009-05-07 |
| 1396808879 | Oxford Endocrinology Consultants, P.C. | Internal Medicine | 512 Azalea Drive, Oxford, MS 38655 | 2006-12-18 |
| 1376553222 | Richard J Galloway | Internal Medicine | 5909 Us Highway 49, Suite 30, Hattiesburg, MS 39401 | 2006-08-09 |
| 1477563104 | Amanda Reagan Schiefer | Internal Medicine | 971 Lakeland Drive, Jackson, MS 39126 | 2006-08-08 |
| 1376559880 | Mark Devin Shepherd | Internal Medicine | 670 Crossover Rd, Tupelo, MS 38801-4944 | 2006-08-01 |
| 1366498677 | Linda Mary Dales | Internal Medicine | 1516 23rd Ave, Meridian, MS 39301-4026 | 2006-05-26 |
| 1588617997 | Beverly Lansden | Internal Medicine | 4540 W Railroad St, Gulfport, MS 39501-2480 | 2006-05-18 |
| 1730138231 | Diabetes & Endocrine Institute, Pllc | Internal Medicine | 2610 Courthouse Cir, Flowood, MS 39232-9562 | 2006-05-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.