Healthcare Provider Details

I. General information

NPI: 1437504719
Provider Name (Legal Business Name): CLAY COUNTY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 HIGH ST
WEST POINT MS
39773-2815
US

IV. Provider business mailing address

328 HIGH ST
WEST POINT MS
39773-2815
US

V. Phone/Fax

Practice location:
  • Phone: 662-854-0694
  • Fax: 662-854-0915
Mailing address:
  • Phone: 662-854-0694
  • Fax: 662-854-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH REPPERT
Title or Position: EXECUTIVE VP
Credential:
Phone: 662-377-3000