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General NPI Number Information
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NPI Number | 1952163206
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Entity Type | Organization
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Legal Business Name | PEDIATRIC & ADOLESCENT CLINIC LLC
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 107 N MARTIN LUTHER KING JR ST
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City | NATCHEZ
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State | MS
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Zip | 39120-3356
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Country | US
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Telephone | 601-442-7676
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Fax | 601-442-9590
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Provider Business Mailing Address
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Address Line | 308 HIGHLAND BLVD
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City | NATCHEZ
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State | MS
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Zip | 39120-4611
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Country | US
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Telephone | 601-442-7676
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Fax | 601-442-9590
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DAVID A TIMM
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Credential | MD
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Telephone | 601-442-7676
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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