Organization
KID'S CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAMMY N HENDERSON M.D. (OWNER)
(601) 427-2752
Entity
Organization
Contact information
Practice address
9325C HIGHWAY 19 N, COLLINSVILLE, MS 39325-9219
(601) 427-2752
(601) 427-2800
Mailing address
9325C HIGHWAY 19 N, COLLINSVILLE, MS 39325-9219
(601) 427-2752
(601) 427-2800
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
13886
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121471
—
MS
Enumeration date
10/12/2006
Last updated
06/04/2013
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