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MAGNOLIA SPECIALTY CLINIC
NPI 1104464395
Internal Medicine - Endocrinology, Diabetes & Metabolism in Corinth, MS

Active since December 18, 2019CLIA 25D2054290 · Waiver
3704 HIGHWAY 72 W, CORINTH, MS 38834(662) 665-8041(662) 665-8049 Get Directions Write a Review

NPPES record last updated: May 14, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 14, 2021, Dec 18, 2019 (2 updates tracked since 2019).

About Magnolia Specialty Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAGNOLIA SPECIALTY CLINIC (NPI 1104464395) is a healthcare organization registered as an endocrinology, diabetes & metabolism in Corinth, Mississippi and active in the NPI registry since December 2019. The organization holds a CLIA Waiver certificate valid through April 19, 2028 and lists Marc Nakagawa, Cfo, as its authorized official.

NPPES Registry Identity

NPI1104464395
Entity TypeOrganization
Primary Taxonomy207RE0101X
Legal Business NameMAGNOLIA SPECIALTY CLINIC
Location Address3704 HIGHWAY 72 WCorinth, MS 38834-8556
Mailing Address401 Alcorn Dr Ste 2cCorinth, MS 38834-9073 · (662) 293-7618 · Fax (662) 293-4358
Phone(662) 665-8041
Fax(662) 665-8049
Organization SubpartNo
Authorized OfficialMarc NakagawaCfo · (662) 293-7660
Enumeration DateDecember 18, 2019
Last NPPES UpdateMay 14, 20212 updates tracked since enumeration
NPPES CertifiedMay 14, 2021
✔ NPI 1104464395 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal Medicine · Endocrinology, Diabetes & MetabolismAllopathic & Osteopathic Physicians
Taxonomy Code207RE0101X
Definition
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
3704 HIGHWAY 72 W, Corinth, MS 38834
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2054290

Magnolia Specialty Clinic · Corinth, MS
Active · expires Apr 19, 2028
CLIA Number25D2054290
Laboratory TypePhysician Office
Certificate Effective DateApril 20, 2026
Certificate Expiration DateApril 19, 2028
Laboratory DirectorDr. Blakley Fowler
Laboratory Phone(662) 665-8041
Laboratory LocationMagnolia Specialty Clinic3207 Mullins Dr, Corinth, MS 38834
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MAGNOLIA REGIONAL HEALTH CENTER
Clinic/Center (Rural Health)
3704 HIGHWAY 72 W
CORINTH, MS 38834
Alcorn County (662) 286-1499
MAGNOLIA NEPHROLOGY CLINIC
Internal Medicine (Nephrology)
3704 HIGHWAY 72 W
CORINTH, MS 38834
Alcorn County (662) 665-8041
HOLLY PETTEY RN
Registered Nurse
3704 HIGHWAY 72 W
CORINTH, MS 38834
Alcorn County (662) 665-8041
MAGNOLIA REGIONAL HEALTH CENTER
Internal Medicine
3704 HIGHWAY 72 W
CORINTH, MS 38834
Alcorn County (662) 286-1499
HOLLEY TRIMBLE
Nurse Practitioner
3704 HIGHWAY 72 W
CORINTH, MS 38834
Alcorn County (662) 286-1499

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Magnolia Specialty Clinic's NPI number?

The NPI number for Magnolia Specialty Clinic is 1104464395. It was assigned to this organization in the NPPES registry on December 18, 2019.

Where is Magnolia Specialty Clinic located?

Magnolia Specialty Clinic is located at 3704 Highway 72 W, Corinth, MS 38834. The listed phone number is (662) 665-8041.

What is Magnolia Specialty Clinic's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

Does Magnolia Specialty Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2054290) is associated with this NPI, valid through April 19, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Magnolia Specialty Clinic was last updated on May 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.