Organization
PEDIATRIC & ADOLESCENT CLINIC OF LOUISIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID TIMM MD (MEDICAL DIRECTOR)
(601) 442-7676
Entity
Organization
Contact information
Practice address
1806 CARTER ST, VIDALIA, LA 71373-3115
(318) 336-7172
(318) 336-7176
Mailing address
308 HIGHLAND BLVD, NATCHEZ, MS 39120-4611
(601) 442-7676
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Enumeration date
04/04/2024
Last updated
04/04/2024
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