Provider Demographics
NPI:1750901179
Name:PEARLS CHILDREN'S CLINIC PLLC
Entity type:Organization
Organization Name:PEARLS CHILDREN'S CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUWAROTIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEPOJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-531-8020
Mailing Address - Street 1:PO BOX 3132
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-3132
Mailing Address - Country:US
Mailing Address - Phone:601-531-8020
Mailing Address - Fax:601-345-2124
Practice Address - Street 1:2507A OLD BRANDON RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4604
Practice Address - Country:US
Practice Address - Phone:601-531-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty