Magnolia Psychiatric PA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

18977 Issued in MS

Legal business name

MAGNOLIA PSYCHIATRIC PA

Practice address

2124 Government St
Ocean Springs, MS 39564-3937

Phone

(228) 818-9050

Fax

(228) 872-6300

NPI assigned

Sep 10, 2007

Last updated

Sep 10, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Tracey L Mattina

Title

Manager

Phone

(228) 818-0563

Specialties & licenses 1

Addresses

Locations

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.

• Anastasia Kelley, MD

  • Psychiatry Physician
  • Ocean Springs, MS
  • NPI 1235228297
  NPD

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189382400000",
    "number": "1306031752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 GOVERNMENT ST",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395643937",
            "telephone_number": "228-818-9050",
            "fax_number": "228-872-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 GOVERNMENT ST",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395643937",
            "telephone_number": "228-818-9050",
            "fax_number": "228-872-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA PSYCHIATRIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2007-09-10",
        "status": "A",
        "authorized_official_last_name": "MATTINA",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "228-818-0563",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MS",
            "license": "18977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• M Aftab Anwar
• Brian Curtis Maddox, D.O.
• Magnolia Counseling Center & Services, LLC
• Magnolia Imaging LLC
• Magnolia Medical Center
• Magnolia Tides Counseling and Consulting
• Maitri Mental Health
• Rhyannen A Majo Smith
• Erum Zafar Malik, MD
• Denise M Martin, SLP

• Psychologist in Ocean Springs, MS
• Providers in Ocean Springs, MS by specialty
• Psychologist in Mississippi

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