| Pediatric & Adolescent Clinic LLC | |
|
107 N Martin Luther King Jr St Natchez MS 39120-3356 | |
| (601) 442-7676 | |
| (601) 442-9590 |
| Full Name | Pediatric & Adolescent Clinic LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 N Martin Luther King Jr St, Natchez, Mississippi |
| Authorized Official Name and Position | David a Timm (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6014427676 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric & Adolescent Clinic LLC 308 Highland Blvd Natchez MS 39120-4611 Ph: (601) 442-7676 | Pediatric & Adolescent Clinic LLC 107 N Martin Luther King Jr St Natchez MS 39120-3356 Ph: (601) 442-7676 |
| NPI Number | 1952163206 |
|---|---|
| Provider Enumeration Date | 01/23/2024 |
| Last Update Date | 10/27/2025 |
| Certification Date | 10/27/2025 |
| Medicare PECOS PAC ID | 5890238091 |
|---|---|
| Medicare Enrollment ID | O20240617000777 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952163206 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (NU) | Primary |
| 208000000X | Pediatrics | (NU) | Secondary |
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