Provider Demographics
NPI:1174608020
Name:DAVID ALAN TIMM
Entity type:Organization
Organization Name:DAVID ALAN TIMM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TIMM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:601-442-7676
Mailing Address - Street 1:308 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4611
Mailing Address - Country:US
Mailing Address - Phone:601-442-7676
Mailing Address - Fax:601-442-9590
Practice Address - Street 1:308 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4611
Practice Address - Country:US
Practice Address - Phone:601-442-7676
Practice Address - Fax:601-442-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC51151041C0700X
MS10207208000000X
LA016299208000000X
MSR691941363LF0000X
LARN066376 APO4870363LF0000X
MSR863841363LF0000X
LARN109495 APO04933363LF0000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446009Medicaid
MS09015251Medicaid
MS09015251Medicaid