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General NPI Number Information
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NPI Number | 1265756951
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Entity Type | Organization
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Legal Business Name | ALL CHILDREN'S CLINIC,PC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 103 HALLS CV
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City | SENATOBIA
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State | MS
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Zip | 38668-6620
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Country | US
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Telephone | 662-562-9003
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Fax | 662-562-4007
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Provider Business Mailing Address
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Address Line | 103 HALLS CV
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City | SENATOBIA
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State | MS
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Zip | 38668-6620
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Country | US
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Telephone | 662-562-9003
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Fax | 662-562-4007
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. DIPIKA P VERMA
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Credential | MBA
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Telephone | 662-562-9003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MS14916
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License Number State | MS
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