Healthcare Provider Details

I. General information

NPI: 1841616265
Provider Name (Legal Business Name): AARON E HENRY COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 W SERVICE DR
COLDWATER MS
38618-3822
US

IV. Provider business mailing address

510 HIGHWAY 322 P O BOX 1216
CLARKSDALE MS
38614-4717
US

V. Phone/Fax

Practice location:
  • Phone: 662-624-4292
  • Fax: 662-624-4354
Mailing address:
  • Phone: 662-624-2504
  • Fax: 662-624-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. AURELIA JONES-TAYLOR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 662-624-4292