Provider Demographics
NPI:1295851640
Name:MORRIS, MAGNOLIA
Entity type:Individual
Prefix:
First Name:MAGNOLIA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAGNOLIA
Other - Middle Name:
Other - Last Name:MAGGETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:644 SEMINOLE
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-1512
Mailing Address - Country:US
Mailing Address - Phone:870-572-3136
Mailing Address - Fax:
Practice Address - Street 1:1825 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3409
Practice Address - Country:US
Practice Address - Phone:870-630-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator