Healthcare Provider Details

I. General information

NPI: 1508984436
Provider Name (Legal Business Name): CLARKSDALE HMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 OHIO AVE SUITE 2F
CLARKSDALE MS
38614-9734
US

IV. Provider business mailing address

580 FRIARS POINT RD
CLARKSDALE MS
38614-9734
US

V. Phone/Fax

Practice location:
  • Phone: 662-621-5081
  • Fax: 662-621-5083
Mailing address:
  • Phone: 662-624-8000
  • Fax: 662-627-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANN NOWELL
Title or Position: PHYSICIAN PRACTICE MANAGER
Credential:
Phone: 662-624-8000