Mallory Community Health

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MALLORY COMMUNITY HEALTH

Practice address

3877 Highway 51
Goodman, MS 39079-9588

Phone

(662) 468-2116

NPI assigned

Jul 22, 2016

Organization subpart

No

Name

Mr. Clyde Rozell Chapman, MD

Title

Chief Executive Officer

Phone

(662) 834-2566

Locations

• Dr. Arenia C. Mallory Community Health Center, Inc. Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 22, 2016.

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469145600000",
    "number": "1104279355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 479",
            "city": "LEXINGTON",
            "state": "MS",
            "postal_code": "390950479",
            "telephone_number": "662-834-1857",
            "fax_number": "662-834-1859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3877 HIGHWAY 51",
            "city": "GOODMAN",
            "state": "MS",
            "postal_code": "390799588",
            "telephone_number": "662-468-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLORY COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-22",
        "last_updated": "2016-07-22",
        "status": "A",
        "authorized_official_last_name": "CHAPMAN",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_middle_name": "ROZELL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "662-834-2566",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Arenia C. Mallory Community Health Center, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Katherine Suzanne Bailey, MS, CCC-SLP
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• Bearing Tree Creek Consulting, LLC
• G a Carmichael Family Health Center, Inc.
• Roneda Denise Lowe, M.S.,CCC-SLP

• All providers in Goodman, MS
• Federally Qualified Health Center (FQHC) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.