Healthcare Provider Details

I. General information

NPI: 1194860502
Provider Name (Legal Business Name): TALLAHATCHIE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 DR. T T LEWIS CIRCLE
CHARLESTON MS
38921-2257
US

IV. Provider business mailing address

PO BOX 230
CHARLESTON MS
38921-0240
US

V. Phone/Fax

Practice location:
  • Phone: 662-647-5535
  • Fax: 662-647-8432
Mailing address:
  • Phone: 662-647-5535
  • Fax: 662-647-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARBARA DOVER CROCKER
Title or Position: HIM DIRECTOR
Credential:
Phone: 662-625-7176