| Healthtrust Magnolia, Llc | |
|
203 S 40th Ave Ste B Hattiesburg MS 39402-1604 | |
| (601) 606-6366 | |
| Not Available |
| Full Name | Healthtrust Magnolia, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 203 S 40th Ave Ste B, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Shelley H Gendusa (MANAGING MEMBER) |
| Authorized Official Contact | 6016066366 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthtrust Magnolia, Llc Po Box 17168 Hattiesburg MS 39404-7168 Ph: () - | Healthtrust Magnolia, Llc 203 S 40th Ave Ste B Hattiesburg MS 39402-1604 Ph: (601) 606-6366 |
| NPI Number | 1144733361 |
|---|---|
| Provider Enumeration Date | 11/09/2017 |
| Last Update Date | 11/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144733361 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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