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Organization

CLEVELAND CHILDREN'S CLINIC, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOSE BREVIL ED.D. (EXECUTIVE DIRECTOR)
(662) 579-3449
Entity
Organization

Contact information

Practice address
818 E SUNFLOWER RD, CLEVELAND, MS 38732-2824
(662) 579-3449
(662) 579-3459
Mailing address
PO BOX 60, CLEVELAND, MS 38732-0060
(662) 579-3449
(662) 579-3469

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
23162
MS
208000000X
Pediatrics Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00325056
MS
Enumeration date
04/04/2016
Last updated
07/20/2023
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