Provider Demographics
NPI:1447449806
Name:COLUMBIA PEDIATRIS, P.C.
Entity type:Organization
Organization Name:COLUMBIA PEDIATRIS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:BALOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-444-9266
Mailing Address - Street 1:PO BOX 1055
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-1055
Mailing Address - Country:US
Mailing Address - Phone:601-444-9266
Mailing Address - Fax:601-444-9267
Practice Address - Street 1:1212 BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3114
Practice Address - Country:US
Practice Address - Phone:601-444-9266
Practice Address - Fax:601-444-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19061208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty