Organization
JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Active
Other names
Jefferson Comprehensive Health Center, Inc. Medical/Dental Mobile Unit
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY ELLIS-STAMPLEY (CEO)
(601) 786-3475
Entity
Organization
Contact information
Practice address
405 MAIN ST, FAYETTE, MS 39069-5576
(601) 786-3475
(601) 786-6320
Mailing address
PO BOX 98, FAYETTE, MS 39069-0098
(601) 786-3475
(601) 786-6320
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
02/21/2020
Last updated
02/21/2020
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