NPIMap

Organization Active NPI

Magnolia Specialty Clinic

  • Endocrinology, Diabetes & Metabolism Physician
  • Corinth, MS
National Provider Identifier
1104464395
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
MAGNOLIA SPECIALTY CLINIC
Practice address
3704 Highway 72 W
Corinth, MS 38834-8556
Phone
(662) 665-8041
Fax
(662) 665-8049
NPI assigned
Dec 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Authorized official

Name
Marc Nakagawa
Title
Cfo
Phone
(662) 293-7660

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

3704 Highway 72 W
Corinth, MS 38834-8556

Mailing address

401 Alcorn Dr Ste 2C
Corinth, MS 38834-9073
Phone (662) 293-7618

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address msc@magnolia.medalliesdirect.net Direct

National Provider Directory

National Provider Directory
Tax ID family
Magnolia Specialty Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • Direct secure messaging: msc@magnolia.medalliesdirect.net

NPI Registry JSON

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

{
    "created_epoch": "1576627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1104464395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 ALCORN DR STE 2C",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388349073",
            "telephone_number": "662-293-7618",
            "fax_number": "662-293-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3704 HIGHWAY 72 W",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388348556",
            "telephone_number": "662-665-8041",
            "fax_number": "662-665-8049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA SPECIALTY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-18",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "NAKAGAWA",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "662-293-7660"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msc@magnolia.medalliesdirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "3704 Highway 72 W",
            "city": "Corinth",
            "state": "MS",
            "country_code": "US",
            "postal_code": "388348556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corinth, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.