Healthcare Provider Details

I. General information

NPI: 1962617530
Provider Name (Legal Business Name): EAST TALLAHATCHIE SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 OAK GROVE ROAD
CHARLESTON MS
38921
US

IV. Provider business mailing address

411 E CHESTNUT ST
CHARLESTON MS
38921-1701
US

V. Phone/Fax

Practice location:
  • Phone: 662-647-5490
  • Fax: 662-647-2113
Mailing address:
  • Phone: 662-647-5524
  • Fax: 662-647-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR855475
License Number StateMS

VIII. Authorized Official

Name: MR. WILLIAM H. TRIBBLE
Title or Position: SUPERINTENDENT
Credential:
Phone: 662-647-5524