MEDICARE: THE CHILDREN'S CLINIC, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1902025752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHILDREN'S CLINIC, PLLC

Provider Business Mailing Address
First Line	:	1513 LAKELAND DR
Second Line	:	SUITE 101
City	:	JACKSON
State	:	MS
Zip	:	39216-4829
Country	:	US
Telephone Number	:	601-362-8233
Fax Number	:	601-362-8237

Provider Business Practice Location Address
First Line	:	1513 LAKELAND DR
Second Line	:	SUITE 101
City	:	JACKSON
State	:	MS
Zip	:	39216-4829
Country	:	US
Telephone Number	:	601-362-8233
Fax Number	:	601-362-8237

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SHEILA M. HARKINS
Credential	:	CMPE
Telephone Number	:	601-362-8233

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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