MAGNOLIA FAMILY MEDICINE, PLLC (NPI# 1699787515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699787515 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA FAMILY MEDICINE, PLLC |
| Practice Address |
415 Marion Ave Suite 399 Mccomb MS 39648-2709 |
| Mailing Address |
1074 Brandon Dr Mccomb MS 39648-6130 |
| Practice Telephone | 6016848800 |
| Practice Fax Number | 6019142937 |
| Mailing Telephone | 6016841633 |
| Mailing Fax Number | 6019142937 |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2009-08-05 |
| Authorized Official Name | LARRY LEE MONTGOMERY (OWNER) |
| Authorized Official Telephone | 6016848800 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 16277 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00120513 | 05 | |
| MS | STATE MEDICAL LICENSE | 16277 | 01 |
| MS | DEA CERTIFICATE | BM5539652 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598212185 | Magnolia Family Medicine, Pllc | Family Medicine | 3 Ceritos Trail, Martinsburg, WV 25403-0300 | 2016-09-01 |
| 1558332114 | Magnolia Family Medicine, Pllc | Family Medicine | 611 Campus Dr, Suite 200, Abingdon, VA 24210-9700 | 2006-01-31 |
| Street Address |
415 MARION AVE SUITE 399 |
| City | MCCOMB |
| State | MS |
| Zip Code | 39648-2709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881238574 | Selena Smith | Physical Therapist | 415 Marion Ave, Mccomb, MS 39648-2709 | 2019-11-05 |
| 1932681244 | Robin Bonds | Physical Therapist | 415 Marion Ave, Mccomb, MS 39648-2709 | 2018-09-04 |
| 1184927956 | Megan Brown | Speech-Language Pathologist | 415 Marion Ave, Mccomb, MS 39648-2709 | 2010-12-16 |
| 1700950789 | Mccomb Nursing and Rehabilitation Center, LLC | Skilled Nursing Facility | 415 Marion Ave, Mccomb, MS 39648-2709 | 2006-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952910366 | Ct Stamps Inc | Pharmacy | 206 Marion Avenue, Mccomb, MS 39648 | 2020-07-31 |
| 1952910457 | Fresenius Medical Care East Mccomb Dialysis, LLC | Clinic/Center | 103 Business Center Drive, Mccomb, MS 39648 | 2020-07-30 |
| 1902423312 | Joseph Edward Mingo II | Counselor | 513 Lee St, Mccomb, MS 39648 | 2020-07-01 |
| 1427608769 | Benda Truvillion | Technician | 2128 Park Dr. Ext., Mccomb, MS 39648 | 2019-09-18 |
| 1295228187 | Edna Ruth Winston | Counselor | Sw Ms Mental Health Complex, 1701 White St, Mccomb, MS 39648 | 2018-06-14 |
| 1386153450 | Sholitha Nunnery | Counselor | 502 North Cherry Street, Mccomb, MS 39648 | 2017-09-21 |
| 1548600612 | Jordan Harrington | Nurse Practitioner | 303 Marion Ave., Mccomb, MS 39648 | 2013-07-03 |
| 1891096236 | Zwound Care | Family Medicine | 1126 Country Club Road, Mccomb, MS 39648 | 2010-11-16 |
| 1588891717 | Kelly Edmondson | Physical Therapy Assistant | 1301a Harrison Ave, Mccomb, MS 39648 | 2009-06-15 |
| 1962647651 | Gwendolyn Michelle Brown | Home Health Aide | 1114 1/2 Venable St., Mccomb, MS 39648 | 2008-12-09 |
| Find all providers in zip 39648 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104174622 | James William Pressler | Family Medicine | 807 Hickory Ave, Mccomb, MS 39648-2213 | 2012-08-15 |
| 1891096236 | Zwound Care | Family Medicine | 1126 Country Club Road, Mccomb, MS 39648 | 2010-11-16 |
| 1114184249 | James L Wootton IIi | Family Medicine | 300 Rawls Dr Ste 1300, Mccomb, MS 39648-2866 | 2008-05-16 |
| 1972620813 | Robert Bayer | Family Medicine | 7049 Pike 93 Central, Mccomb, MS 39648-9203 | 2007-03-24 |
| 1619926433 | Daniel Boone | Family Medicine | 300 Rawls Dr Ste 600, Mccomb, MS 39648-2862 | 2006-05-09 |
| 1023067360 | Glenn Zeidman | Family Medicine | 1126 Country Club Rd, Mccomb, MS 39648-5952 | 2006-05-05 |
| 1699759704 | Ronald Jack Morgan | Family Medicine | 215 Marion Ave, Mccomb, MS 39648 | 2005-12-01 |
| 1578084521 | Christopher Harvey Bracey | Family Medicine | 1017 Delaware Ave, Mccomb, MS 39648-3827 | 2017-06-29 |
| 1215378989 | Compassionate Medical Services, Inc. | Family Medicine | 150 Marion Ave, Mccomb, MS 39648-3620 | 2013-07-10 |
| 1770874687 | Kevin Ricks | Family Medicine | 300 Rawls Dr Ste 1500, Mccomb, MS 39648-2878 | 2011-04-26 |
| Find all providers in MCCOMB | ||||
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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.