Magnolia Professional Associates

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

MAGNOLIA PROFESSIONAL ASSOCIATES

Practice address

703 Alcorn Drive
109
Corinth, MS 38834-9323

Phone

(662) 286-2522

Fax

(662) 293-4288

NPI assigned

Jul 22, 2006

Organization subpart

No

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

Authorized official

Name

Jason Coley

Title

Executive Director Physician Servic

Phone

(662) 293-7678

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Interoperability endpoints

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mathew Bowen Johnson Jr., M.D.

  • Surgery Physician
  • Corinth, MS
  • NPI 1134142334
  Medicare reassignment NPD

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1366463549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2040",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388352040",
            "telephone_number": "662-286-2522",
            "fax_number": "662-293-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 ALCORN DRIVE",
            "address_2": "109",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388349323",
            "telephone_number": "662-286-2522",
            "fax_number": "662-293-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA PROFESSIONAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2021-05-14",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "COLEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR PHYSICIAN SERVIC",
        "authorized_official_telephone_number": "662-293-7678"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05323894",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpa@magnolia.medalliesdirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "703 Alcorn Drive",
            "address_2": "109",
            "city": "Corinth",
            "state": "MS",
            "country_code": "US",
            "postal_code": "388349323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Magnolia Nephrology Clinic
• Magnolia Orthopaedics & Sports Medicine, P.a.
• Magnolia Pediatric Clinic
• Magnolia Physician Services, Inc
• Magnolia Primary Care
• Magnolia Professional Billing
• Magnolia Regional Behavioral Health Services
• Magnolia Regional Community Care Clinic
• Magnolia Regional Health Center
• Magnolia Regional Health Center

• Surgery Physician in Corinth, MS
• Providers in Corinth, MS by specialty
• Surgery Physician in Mississippi

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.