Healthcare Provider Details

I. General information

NPI: 1164961330
Provider Name (Legal Business Name): CLAY COUNTY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MEDICAL CENTER DR
WEST POINT MS
39773-0428
US

IV. Provider business mailing address

808 VARSITY DR
TUPELO MS
38801-4613
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-1509
  • Fax: 662-494-5928
Mailing address:
  • Phone: 662-377-2774
  • Fax: 662-377-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10281
License Number StateHI

VIII. Authorized Official

Name: BRUCE TOPPIN
Title or Position: SECRETARY
Credential:
Phone: 662-377-4229