NPIMap

Organization Active NPI

Magnolia Family Dentistry of Columbus, Inc.

  • General Practice Dentistry
  • Columbus, MS
National Provider Identifier
1043533623
Registry record updated Mar 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3463-08 Issued in MS
Legal business name
MAGNOLIA FAMILY DENTISTRY OF COLUMBUS, INC.
Practice address
2401 5TH St N Ste 2
Columbus, MS 39705-2005
Phone
(662) 328-8001
Fax
(888) 852-8644
NPI assigned
Mar 10, 2010
Last updated
Mar 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2010

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

Authorized official

Name
Dr. Donnie J. Richardson Jr., DMDNPI 1699956565
Title
Owner/Ceo
Phone
(662) 328-8001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 3463-08 MS Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 1860-79 MS
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 3160-00 MS

Addresses

Primary practice location

2401 5TH St N Ste 2
Columbus, MS 39705-2005

Mailing address

2401 5TH St N Ste 2
Columbus, MS 39705-2005
Phone (662) 328-8001

Other identifiers 1

IdentifierTypeStateIssuer
02150825MedicaidMS

National Provider Directory

National Provider Directory

Locations

2401 5th St N
#2
Columbus, MS 39705
Phone (662) 328-8001

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268179200000",
    "number": "1043533623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 5TH ST N STE 2",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052005",
            "telephone_number": "662-328-8001",
            "fax_number": "888-852-8644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 5TH ST N STE 2",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052005",
            "telephone_number": "662-328-8001",
            "fax_number": "888-852-8644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA FAMILY DENTISTRY OF COLUMBUS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-10",
        "last_updated": "2010-03-10",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "DONNIE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "662-328-8001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3463-08",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "1860-79",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3160-00",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02150825",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; 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.