Active NPI
Magnolia Woman'S Clinic, P.a.
- Obstetrics Physician
- Jackson, MS
National Provider Identifier
1144491580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics Physician
- License
- 11096
- Legal business name
- MAGNOLIA WOMAN'S CLINIC, P.A.
- Practice address
- 970 Lakeland Dr
Suite 43
Jackson, MS 39216-4635 - Phone
- (601) 200-8201
- NPI assigned
- Mar 13, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Walter Ray Wolfe, M.D.
- Title
- Owner/President
- Phone
- (601) 200-8201
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics Physician | 207VX0000X | 11096 | MS | Primary |
Addresses
Primary practice location
970 Lakeland Dr
Suite 43
Jackson, MS 39216-4635
Mailing address
970 Lakeland Dr
Suite 43
Jackson, MS 39216-4635
Phone (601) 200-8201
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00131201 | Medicaid | MS | |
| 4224712 | Other | AETNA | |
| 7430106 | Other | MS | UNITED HEALTH CARE |
| 428940305A | Other | MS | BLUE CROSS BLUE SHEILD |
National Provider Directory
National Provider DirectoryLocations
163 River Oaks Dr
Ste 204
Canton, MS 39046
Phone (601) 855-4880
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205366400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1205366400000",
"number": "1144491580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "970 LAKELAND DR",
"address_2": "SUITE 43",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164635",
"telephone_number": "601-200-8201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "970 LAKELAND DR",
"address_2": "SUITE 43",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164635",
"telephone_number": "601-200-8201"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAGNOLIA WOMAN'S CLINIC, P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2008-03-13",
"last_updated": "2008-03-13",
"status": "A",
"authorized_official_last_name": "WOLFE",
"authorized_official_first_name": "WALTER",
"authorized_official_middle_name": "RAY",
"authorized_official_title_or_position": "OWNER/PRESIDENT",
"authorized_official_telephone_number": "601-200-8201",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207VX0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology, Obstetrics",
"state": "MS",
"license": "11096",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00131201",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4224712",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "7430106",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHEILD",
"identifier": "428940305A",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.