Healthcare Provider Details

I. General information

NPI: 1952630089
Provider Name (Legal Business Name): CLYDE ROZELL CHAPMAN II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2009
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W S F TATUM BLVD
HATTIESBURG MS
39401
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-450-0805
  • Fax: 601-450-0806
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-255-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22207
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.124688
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: