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CAPITAL CITY CHILDREN AND ADOLESCENT CLINIC NPI 1912088790


NPI Information

NPI: 1912088790
Provider Name: CAPITAL CITY CHILDREN AND ADOLESCENT CLINIC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 25D0947701

Address:
2679 CRANE RIDGE DR
STE F
JACKSON, MS
ZIP 39216
Phone: (601) 362-7476
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CAPITAL CITY CHILDREN AND ADOLESCENT CLINIC is a pediatrics in Jackson, MS. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. CAPITAL CITY CHILDREN AND ADOLESCENT CLINIC NPI is 1912088790. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2679 CRANE RIDGE DR
STE F
JACKSON, MS
ZIP 39216-997
Phone: (601) 362-7476

The provider's authorized official is Geraldine Chaney .
The authorized official title is Owner and has the following contact phone number (601) 362-7476.

The CLIA number assigned to this NPI record is 25D0947701 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/18/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
109016857MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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