Magnolia Family Medicine, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

16277 Issued in MS

Legal business name

MAGNOLIA FAMILY MEDICINE, PLLC

Practice address

415 Marion Ave
Suite 399
McComb, MS 39648-2709

Phone

(601) 684-8800

Fax

(601) 914-2937

NPI assigned

Aug 12, 2006

Organization subpart

No

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

Authorized official

Name

Larry Lee Montgomery, M.D.

Title

Owner

Phone

(601) 684-8800

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GBBBDA

Practitioners 2

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

• Tammy Lofton Dixon, FNP

  • Family Nurse Practitioner
  • Brookhaven, MS
  • NPI 1255593364
  NPD (past)
• Jennifer Gholson, MD

  • Family Medicine Physician
  • Summit, MS
  • NPI 1174588834
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1699787515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1074 BRANDON DR",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396486130",
            "telephone_number": "601-684-1633",
            "fax_number": "601-914-2937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MARION AVE",
            "address_2": "SUITE 399",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482709",
            "telephone_number": "601-684-8800",
            "fax_number": "601-914-2937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-684-8800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "16277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120513",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "16277",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Bryant Luckett, DMD
• Weatherby Lunsford
• Kimberly Lyles, MSW
• Janice Lyons
• Christie Magee, LSW
• Ivan Kai Makiyama, DO
• Angel Marshall
• Debra Ann Marshall
• Martha Dale Kristiansen
• Irene Martin, CFNP

• Family Medicine Physician in McComb, MS
• Providers in McComb, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.