Healthcare Provider Details

I. General information

NPI: 1235547878
Provider Name (Legal Business Name): CHOCTAW REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 05/28/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 N LOUISVILLE ST
ACKERMAN MS
39735-9217
US

IV. Provider business mailing address

8613 MS HIGHWAY 12
ACKERMAN MS
39735-8917
US

V. Phone/Fax

Practice location:
  • Phone: 662-285-9050
  • Fax:
Mailing address:
  • Phone: 662-285-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HOLLINGSWORTH
Title or Position: ADMINISTRATOR & CREDENTIALING
Credential:
Phone: 662-285-9460