Healthcare Provider Details

I. General information

NPI: 1134868672
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: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 N STATE ST
CLARKSDALE MS
38614-6102
US

IV. Provider business mailing address

PO BOX 1216
CLARKSDALE MS
38614-1216
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 Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CANDACE L FONDREN
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 662-624-4292