| Aurelia Jones - Taylor Administrative Complex | |
|
600 Ohio Ave Clarksdale MS 38614-6020 | |
| (662) 624-4292 | |
| (662) 351-3303 |
| Full Name | Aurelia Jones - Taylor Administrative Complex |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 600 Ohio Ave, Clarksdale, Mississippi |
| Authorized Official Name and Position | Candace L Fondren (REVENUE CYCLE MANAGER) |
| Authorized Official Contact | 6626244292 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aurelia Jones - Taylor Administrative Complex Po Box 1216 Clarksdale MS 38614-1216 Ph: (662) 624-4292 | Aurelia Jones - Taylor Administrative Complex 600 Ohio Ave Clarksdale MS 38614-6020 Ph: (662) 624-4292 |
| NPI Number | 1104574847 |
|---|---|
| Provider Enumeration Date | 03/11/2022 |
| Last Update Date | 08/19/2022 |
| Certification Date | 08/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104574847 | NPI | - | NPPES |
| 09010039 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
| 152W00000X | Optometrist | (NU) | Secondary |
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