Organization
LAFAYETTE PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA JEAN FITTS M.D. (OWNER)
(662) 236-3939
Entity
Organization
Contact information
Practice address
2166 S LAMAR BLVD, OXFORD, MS 38655-5224
(662) 236-3939
(662) 236-3924
Mailing address
2166 S LAMAR BLVD, OXFORD, MS 38655-5224
(662) 236-3939
(662) 236-3924
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
17111
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125498
—
MS
Enumeration date
10/10/2007
Last updated
03/17/2010
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