Healthcare Provider Details

I. General information

NPI: 1104006923
Provider Name (Legal Business Name): PEACE CHILDREN'S CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CLINTON PLZ
CLINTON MS
39056-5126
US

IV. Provider business mailing address

210 CLINTON PLZ
CLINTON MS
39056-5126
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-2008
  • Fax: 601-924-2022
Mailing address:
  • Phone: 601-924-2008
  • Fax: 601-924-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUISA E LAWSON
Title or Position: OWNER
Credential: MD
Phone: 601-924-2008