Basic Information
| Provider Information | |||||||||
| NPI: | 1952630089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAPMAN | ||||||||
| FirstName: | CLYDE | ||||||||
| MiddleName: | ROZELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3648 JONES LOOP | ||||||||
| Address2: | |||||||||
| City: | TERRY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391709248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014623532 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17280 HIGHWAY 17 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390956614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628341857 | ||||||||
| FaxNumber: | 6628341859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2009 | ||||||||
| LastUpdateDate: | 07/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036.124688 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 22207 | MS | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.