Pediatric & Adolescent Clinic LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PEDIATRIC & ADOLESCENT CLINIC LLC

Practice address

107 N Martin Luther King Jr St
Natchez, MS 39120-3356

Phone

(601) 442-7676

Fax

(601) 442-9590

NPI assigned

Jan 23, 2024

Organization subpart

No

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

Authorized official

Name

Dr. David A Timm, MDNPI 1023194867

Title

Medical Director

Phone

(601) 442-7676

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Rural health clinic certification: CCN A53841

Legal name

PEDIATRIC & ADOLESCENT CLINIC LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 19, 2024

Last certification

Nov 19, 2024

Ownership / control type

1B

Organization structure

LLCProprietary

Enrollment address

107 N Martin Luther King Jr St
Natchez, MS 39120-3356

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Alan Timm, M.D.

  • Pediatrics Physician
  • Natchez, MS
  • NPI 1023194867
  NPD Authorized official

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

{
    "created_epoch": "1705968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761523200000",
    "number": "1952163206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 HIGHLAND BLVD",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391204611",
            "telephone_number": "601-442-7676",
            "fax_number": "601-442-9590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N MARTIN LUTHER KING JR ST",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391203356",
            "telephone_number": "601-442-7676",
            "fax_number": "601-442-9590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC & ADOLESCENT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-23",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A",
        "authorized_official_last_name": "TIMM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "601-442-7676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Celia F Peeples, MSCCCSLP
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• Evelyn D Peters, LMSW
• Phonex Family Life Center

• Rural Health Clinic/Center in Natchez, MS
• Providers in Natchez, MS by specialty
• Rural Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.