Organization
CAPITAL CITY CHILDREN AND ADOLESCENT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALDINE CHANEY (OWNER)
(601) 362-7476
Entity
Organization
Contact information
Practice address
2679 CRANE RIDGE DR, STE F, JACKSON, MS 39216-4997
(601) 362-7476
Mailing address
2679 CRANE RIDGE DR, STE F, JACKSON, MS 39216-4997
(601) 362-7476
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016857
—
MS
Enumeration date
10/18/2006
Last updated
08/22/2020
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