Healthcare Provider Details

I. General information

NPI: 1659555761
Provider Name (Legal Business Name): TALLAHATCHIE GENERAL HOSPITAL AND EXTENDED CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DR T. T. LEWIS CIRCLE
CHARLESTON MS
38921
US

IV. Provider business mailing address

PO BOX 230
CHARLESTON MS
38921
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 Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1054
License Number StateMS

VIII. Authorized Official

Name: HEATHER HOLEMAN GODSEY
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 662-625-7191