| NPI | 1114201423 |
|---|---|
| Doing Business As | MAGNOLIA DME |
| Entity Type | Organization |
| Authorized Contact | ROBERT S CROCKETT Member 601-286-3745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MS 80193) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |