Provider Demographics
NPI:1225534530
Name:MAGNOLIA ALLERGY AND SKIN CARE
Entity Type:Organization
Organization Name:MAGNOLIA ALLERGY AND SKIN CARE
Other - Org Name:MAGNOLIA ALLERGY CLINIC LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:601-519-9562
Mailing Address - Street 1:124 HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-6602
Mailing Address - Country:US
Mailing Address - Phone:601-519-9562
Mailing Address - Fax:
Practice Address - Street 1:102 E LEAKE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4204
Practice Address - Country:US
Practice Address - Phone:601-519-9562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22223207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty