Healthcare Provider Details

I. General information

NPI: 1467391391
Provider Name (Legal Business Name): CAMMIE E KITCHENS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SONJA DAVIS KITCHENS

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 CHERRY STONE CIR
CLINTON MS
39056-2024
US

IV. Provider business mailing address

942 CHERRY STONE CIR
CLINTON MS
39056-2024
US

V. Phone/Fax

Practice location:
  • Phone: 601-954-3772
  • Fax:
Mailing address:
  • Phone: 601-954-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: