Provider Demographics
NPI:1942413216
Name:MAGNOLIA MEDICAL GROUP P A
Entity Type:Organization
Organization Name:MAGNOLIA MEDICAL GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER-MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-981-9545
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-981-9545
Mailing Address - Fax:601-981-9546
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 400
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-981-9545
Practice Address - Fax:601-981-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty