Healthcare Provider Details

I. General information

NPI: 1972603819
Provider Name (Legal Business Name): COPIAH COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BO BO DR
CRYSTAL SPRINGS MS
39059
US

IV. Provider business mailing address

27190 HWY 28
HAZLEHURST MS
39083
US

V. Phone/Fax

Practice location:
  • Phone: 601-892-2225
  • Fax: 601-892-1456
Mailing address:
  • Phone: 601-574-7000
  • Fax: 601-892-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: KORTNEY M. GADDY
Title or Position: CFO
Credential:
Phone: 601-574-7200