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: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17280 HIGHWAY 17
LEXINGTON MS
39095-6614
US

IV. Provider business mailing address

3648 JONES LOOP
TERRY MS
39170-9248
US

V. Phone/Fax

Practice location:
  • Phone: 662-834-1857
  • Fax: 662-834-1859
Mailing address:
  • Phone: 601-462-3532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: