Healthcare Provider Details

I. General information

NPI: 1235081118
Provider Name (Legal Business Name): COMMUNITY FAMILY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N FRONT ST
RICHTON MS
39476-2204
US

IV. Provider business mailing address

PO BOX 689
RICHTON MS
39476-0689
US

V. Phone/Fax

Practice location:
  • Phone: 601-788-2599
  • Fax: 601-788-6719
Mailing address:
  • Phone: 601-788-2599
  • Fax: 601-788-6719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: EDRICK HIBBLER
Title or Position: MANAGER
Credential:
Phone: 601-788-2599