Organization
PEDIATRIC CARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ASHRAF TABATABAII MD (OWNER)
(985) 726-2655
Entity
Organization
Contact information
Practice address
421 RIVER RD, PICAYUNE, MS 39466-3160
(985) 726-2655
(985) 643-9808
Mailing address
421 RIVER RD, PICAYUNE, MS 39466-3160
(985) 726-2655
(985) 643-9808
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
10074
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015403
—
MS
Enumeration date
06/04/2009
Last updated
06/04/2009
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