Provider Demographics
NPI:1386073294
Name:MAGNOLIA IMAGING ASSOCIATES, PLLC
Entity type:Organization
Organization Name:MAGNOLIA IMAGING ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-626-0296
Mailing Address - Street 1:PO BOX 9186
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-9186
Mailing Address - Country:US
Mailing Address - Phone:662-293-1477
Mailing Address - Fax:
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9321
Practice Address - Country:US
Practice Address - Phone:662-293-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty