Provider Demographics
NPI:1437908696
Name:DISCOVERY DEVELOPMENTAL PEDIATRICS PLLC
Entity type:Organization
Organization Name:DISCOVERY DEVELOPMENTAL PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLZEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-255-2214
Mailing Address - Street 1:108 MUSCADINE HL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7608
Mailing Address - Country:US
Mailing Address - Phone:801-913-6623
Mailing Address - Fax:
Practice Address - Street 1:3000 OLD CANTON RD STE 240
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4235
Practice Address - Country:US
Practice Address - Phone:601-255-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty