Healthcare Provider Details

I. General information

NPI: 1003152141
Provider Name (Legal Business Name): FORREST COUNTY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 SUMRALL RD
COLUMBIA MS
39429-2654
US

IV. Provider business mailing address

1560 SUMRALL RD
COLUMBIA MS
39429-2654
US

V. Phone/Fax

Practice location:
  • Phone: 601-736-6303
  • Fax: 601-740-2244
Mailing address:
  • Phone: 601-736-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD ANDREW WOODARD
Title or Position: CFO
Credential:
Phone: 601-288-2892