Healthcare Provider Details

I. General information

NPI: 1861424145
Provider Name (Legal Business Name): CENTRAL MISSISSIPPI CIVIC IMROVEMENT ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 HIGHWAY 27
UTICA MS
39175-9226
US

IV. Provider business mailing address

3502 W NORTHSIDE DR
JACKSON MS
39213-4454
US

V. Phone/Fax

Practice location:
  • Phone: 601-882-6021
  • Fax: 601-885-2268
Mailing address:
  • Phone: 601-362-5321
  • Fax: 601-364-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JASMIN CHAPMAN
Title or Position: CEO
Credential: DDS
Phone: 601-362-5321