Healthcare Provider Details

I. General information

NPI: 1023194867
Provider Name (Legal Business Name): DAVID ALAN TIMM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HIGHLAND BLVD
NATCHEZ MS
39120-4611
US

IV. Provider business mailing address

308 HIGHLAND BLVD
NATCHEZ MS
39120-4611
US

V. Phone/Fax

Practice location:
  • Phone: 601-442-7676
  • Fax: 601-442-9590
Mailing address:
  • Phone: 601-442-7676
  • Fax: 601-442-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number016299
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10207
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: