Cherry Gay Clark, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

07972 Issued in MS

Practice address

18199 Highway 80
Hickory, MS 39332-0220

Phone

(601) 646-5445

Fax

(601) 646-5446

NPI assigned

Aug 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hickory Family Medical Clinic Inc

  • Family Medicine Physician
  • Hickory, MS
  • NPI 1093284366
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336251271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "HICKORY",
            "state": "MS",
            "postal_code": "393320220",
            "telephone_number": "601-646-5445",
            "fax_number": "601-646-5446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18199 HIGHWAY 80",
            "city": "HICKORY",
            "state": "MS",
            "postal_code": "393320220",
            "telephone_number": "601-646-5445",
            "fax_number": "601-646-5446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHERRY",
        "middle_name": "GAY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "07972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00114924",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Demetra Dawkins-Allen, FNP-BC
• Malori Claire Gallaspy
• Elizabeth Connell Henderson, MD
• Hickory Family Medical Clinic Inc
• Hidden Oaks Transportation LLC

• Family Medicine Physician in Hickory, MS
• Providers in Hickory, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.