Organization
TRINITY PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY U ROBERTSON MD (MANAGER)
(601) 376-2857
Entity
Organization
Contact information
Practice address
1860 CHADWICK DR, SUITE 205, JACKSON, MS 39204-3463
(601) 376-2857
Mailing address
1860 CHADWICK DR, SUITE 205, JACKSON, MS 39204-3463
(601) 376-2857
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118818
—
MS
Enumeration date
04/29/2011
Last updated
04/29/2011
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