Provider Demographics
NPI:1437175270
Name:THE MAGNOLIA WOMEN'S CLINIC, P.A.
Entity type:Organization
Organization Name:THE MAGNOLIA WOMEN'S CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-286-6090
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-0779
Mailing Address - Country:US
Mailing Address - Phone:662-286-6090
Mailing Address - Fax:662-286-7008
Practice Address - Street 1:512 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9392
Practice Address - Country:US
Practice Address - Phone:662-286-6090
Practice Address - Fax:662-286-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014637Medicaid
MSC03403Medicare PIN