MAGNOLIA GASTROENTEROLOGY CLINIC, LLC (NPI# 1518941731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518941731 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA GASTROENTEROLOGY CLINIC, LLC |
| Other Organization Name | CORINTH GASTROENTEROLOGY CLINIC, LLC |
| Practice Address |
3050 Corder Drive Magnolia Gastroenterology Clinic, LLC Corinth MS 38834 |
| Mailing Address |
Po Box 600 Corinth MS 38835-0600 |
| Practice Telephone | 6622849902 |
| Practice Fax Number | 6622849904 |
| Mailing Telephone | 6622849902 |
| Mailing Fax Number | 6622849904 |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. FREDRICK ALVIN CORDER (OWNER/PHYSICIAN/MEDICAL DIRECTOR) |
| Authorized Official Telephone | 6622849902 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09016046 | 05 |
| Other Name | Type Code |
|---|---|
| Corinth Gastroenterology Clinic, LLC | Former Legal Business Name - Organization |
| Street Address |
3050 CORDER DRIVE MAGNOLIA GASTROENTEROLOGY CLINIC, LLC |
| City | CORINTH |
| State | MS |
| Zip Code | 38834 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710961982 | Frederick Alvin Corder | Internal Medicine | 3050 Corder Drive, Corinth, MS 38834 | 2005-12-01 |
| 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 | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| 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 |
|---|---|---|---|---|
| 1710961982 | Frederick Alvin Corder | Internal Medicine | 3050 Corder Drive, Corinth, MS 38834 | 2005-12-01 |
| 1700871340 | John Robert Davis | Internal Medicine | 815 Childs St, Corinth, MS 38834-4934 | 2005-09-20 |
| 1497918593 | Catherine Vadime Netchvolodoff | Internal Medicine | 3050 Corder Dr, Corinth, MS 38834-6210 | 2008-07-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902374085 | St. Dominic Medical Associates LLC | Internal Medicine | 970 Lakeland Dr Ste 43, Jackson, MS 39216-4634 | 2018-11-07 |
| 1558774174 | Stephen Robert Chow | Internal Medicine | 1314 19th Ave Dept Of, Meridian, MS 39301-4116 | 2014-06-11 |
| 1568653939 | M Aftab Anwar | Internal Medicine | 3704 Beinville Blvd, Ocean Springs, MS 39564 | 2007-08-09 |
| 1720202450 | Amory Hma Physician Mgmt LLC | Internal Medicine | 1127 Earl Frye Blvd Ste A, Amory, MS 38821-5516 | 2007-04-12 |
| 1568594893 | Mohammad Aftab Anwar | Internal Medicine | 3704 Bienville Blvd, Suite A3, Ocean Springs, MS 39564-5710 | 2007-03-12 |
| 1740353515 | Deborah S. Skelton | Internal Medicine | 971 Lakeland Dr Ste 1160, Jackson, MS 39216-4609 | 2006-11-17 |
| 1902984966 | R Andrew Packard Md PC | Internal Medicine | 785 Ohio Ave Ste 1f, Clarksdale, MS 38614-6213 | 2006-11-01 |
| 1376659193 | Navin V Barot | Internal Medicine | 1340 Broad Ave Ste 300, Gulfport, MS 39501-2404 | 2006-08-22 |
| 1437265972 | Javed Mohiuddin | Internal Medicine | Gulf Coast Veterans Health Care System, 400 Veterans Avenue, Biloxi, MS 39531-2410 | 2006-08-21 |
| 1558374850 | William M Farmer | Internal Medicine | 100 Methodist Blvd, Hattiesburg, MS 39402-1295 | 2006-08-15 |
| 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.