Capital City Children and Adolescent Clinic

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

CAPITAL CITY CHILDREN AND ADOLESCENT CLINIC

Practice address

2679 Crane Ridge Dr
Ste F
Jackson, MS 39216-4997

Phone

(601) 362-7476

NPI assigned

Oct 18, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Geraldine ChaneyNPI 1699716241

Title

Owner

Phone

(601) 362-7476

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Geraldine Chaney, MD

  • Pediatrics Physician
  • Jackson, MS
  • NPI 1699716241
  NPD (past) Authorized official
• Kenneth Aaron Yung, MD

  • Pediatrics Physician
  • Jackson, MS
  • NPI 1598712994
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912088790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2679 CRANE RIDGE DR",
            "address_2": "STE F",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164997",
            "telephone_number": "601-362-7476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2679 CRANE RIDGE DR",
            "address_2": "STE F",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164997",
            "telephone_number": "601-362-7476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL CITY CHILDREN AND ADOLESCENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHANEY",
        "authorized_official_first_name": "GERALDINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-362-7476"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016857",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• D Timothy Cannon, M.D.
• Ericia Latrice Cannon, NURSE PRACTITONER
• Lauren Elizabeth Cantrell
• Meagan Cantrelle
• Christopher Thai Cao, PHARMD
• Capital City Endocrine Clinic LLC
• Capital Dental Inc
• Capitol Medical Supply, Inc
• Capitol Medical Supply, Inc
• Capitol Physical Therapy, PA

• Pediatrics Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.