Healthcare Provider Details

I. General information

NPI: 1346734373
Provider Name (Legal Business Name): TALLAHATCHIE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W WALNUT ST
CHARLESTON MS
38921-2242
US

IV. Provider business mailing address

109 W WALNUT ST
CHARLESTON MS
38921-2242
US

V. Phone/Fax

Practice location:
  • Phone: 662-647-5172
  • Fax:
Mailing address:
  • Phone: 662-647-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: HEATHER GODSEY
Title or Position: RE
Credential:
Phone: 662-625-7191