| NPI | 1174608020 |
|---|---|
| Doing Business As | PEDIATRIC & ADOLESCENT CLINIC |
| Entity Type | Organization |
| Authorized Contact | DAVID ALAN TIMM Owner 601-442-7676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS C5115) |
| 208000000X Pediatrics (Licence: MS 10207) | |
| 208000000X Pediatrics (Licence: LA 016299) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MS R691941) | |
| 363LF0000X Nurse Practitioner, Family (Licence: LA rn066376 apo4870) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MS r863841) | |
| 363LF0000X Nurse Practitioner, Family (Licence: LA RN109495 APO04933) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2008-01-02 |