Healthcare Provider Details

I. General information

NPI: 1598649691
Provider Name (Legal Business Name): AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 OHIO AVE
CLARKSDALE MS
38614-6020
US

IV. Provider business mailing address

600 OHIO AVE
CLARKSDALE MS
38614-6020
US

V. Phone/Fax

Practice location:
  • Phone: 662-624-4292
  • Fax: 662-624-4354
Mailing address:
  • Phone: 662-624-4292
  • Fax: 662-624-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: LAQUITTA R GREEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 662-624-4292