Provider Demographics
NPI:1760442164
Name:MAGNOLIA PEDIATRICS SOUTH INC
Entity Type:Organization
Organization Name:MAGNOLIA PEDIATRICS SOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECT-TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAMOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-930-9500
Mailing Address - Street 1:1621 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1621 11TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4703
Practice Address - Country:US
Practice Address - Phone:205-930-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty