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General NPI Number Information
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NPI Number | 1811425291
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Entity Type | Organization
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Legal Business Name | CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 7255 GARY RD
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City | BYRAM
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State | MS
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Zip | 39272-8947
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Country | US
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Telephone | 601-894-8590
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Fax |
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Provider Business Mailing Address
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Address Line | 3502 W NORTHSIDE DR
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City | JACKSON
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State | MS
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Zip | 39213-4454
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Country | US
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Telephone | 601-362-5321
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Fax | 601-364-5159
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JASMIN CHAPMAN
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Credential | DDS
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Telephone | 601-364-5142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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