Organization
DAVID ALAN TIMM
Active
Other names
PEDIATRIC & ADOLESCENT CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID ALAN TIMM MD (OWNER)
(601) 442-7676
Entity
Organization
Contact information
Practice address
1806 CARTER ST, VIDALIA, LA 71373-3115
(318) 336-7172
(318) 336-7176
Mailing address
1806 CARTER ST, VIDALIA, LA 71373-3115
(318) 336-7172
(318) 336-7176
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
016299
LA
208000000X
Pediatrics Physician
MD016299
LA
363LF0000X
Family Nurse Practitioner
APO4870
LA
363LF0000X
Family Nurse Practitioner
APO4933
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021829
—
LA
Enumeration date
03/02/2007
Last updated
12/09/2009
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