Magnolia Family Medical Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

17503 Issued in MS

Legal business name

MAGNOLIA FAMILY MEDICAL CLINIC

Practice address

1660 S Colorado St
Greenville, MS 38703-7216

Phone

(662) 332-2077

Fax

(662) 332-0790

NPI assigned

May 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John B Kayoma, MD

Title

Owner

Phone

(662) 332-2077

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199059200000",
    "number": "1023228632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 S COLORADO ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037216",
            "telephone_number": "662-332-2077",
            "fax_number": "662-332-0790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 S COLORADO ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037216",
            "telephone_number": "662-332-2077",
            "fax_number": "662-332-0790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-12-31",
        "status": "A",
        "authorized_official_last_name": "KAYOMA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-332-2077",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "17503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MS",
            "identifier": "578968167B",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01722576",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Greenville, MS
• Providers in Greenville, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.