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General NPI Number Information
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NPI Number | 1033210315
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Entity Type | Organization
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Legal Business Name | NATCHEZ PEDIATRIC CLINIC PLLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 136 JEFFERSON DAVIS BLVD. SUITE A
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City | NATCHEZ
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State | MS
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Zip | 39120
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Country | US
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Telephone | 601-442-5439
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Fax | 601-442-3755
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Provider Business Mailing Address
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Address Line | PO BOX 17918
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City | NATCHEZ
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State | MS
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Zip | 39122-7918
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Country | US
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Telephone | 601-442-5439
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Fax | 601-442-3755
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | JAMES M MAYO
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Credential |
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Telephone | 601-442-5439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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