Magnolia NA, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

848 Issued in MS

Legal business name

MAGNOLIA NA, LLC

Practice address

117 N Broadway St
Tupelo, MS 38804-3901

Phone

(662) 840-3111

Fax

(662) 840-3119

NPI assigned

Apr 26, 2012

Organization subpart

No

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

Authorized official

Name

Art Shannon

Title

Chief Operating Officer

Phone

(662) 891-3054

Specialties & licenses 1

Addresses

Other names 1

• Magnolia Place of New Albany Other name

Locations

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

{
    "created_epoch": "1335398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335398400000",
    "number": "1245598390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 MUNSFORD DR",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386527407",
            "telephone_number": "662-534-0046",
            "fax_number": "662-534-0393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 N BROADWAY ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388043901",
            "telephone_number": "662-840-3111",
            "fax_number": "662-840-3119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA NA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-26",
        "last_updated": "2012-04-26",
        "status": "A",
        "authorized_official_last_name": "SHANNON",
        "authorized_official_first_name": "ART",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "16628913054"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Place of New Albany",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Magnolia Medical, LLC
• Magnolia Psychiatric Services PLLC
• Magnolia Therapy Services (Magnolia Kids Therapy)
• Saba Mahmoud
• Amita Maibam, M.D.
• Main Street Family Dentistry PA

• Assisted Living Facility in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Assisted Living Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; 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.