Healthcare Provider Details

I. General information

NPI: 1336256700
Provider Name (Legal Business Name): FORREST COUNTY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MAMIE ST STE 120
HATTIESBURG MS
39402-1749
US

IV. Provider business mailing address

1414 SOUTH 28TH AVE
HATTIESBURG MS
39402
US

V. Phone/Fax

Practice location:
  • Phone: 601-288-4344
  • Fax: 601-288-2401
Mailing address:
  • Phone: 601-288-4344
  • Fax: 601-288-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4585
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number008
License Number StateMS

VIII. Authorized Official

Name: LESLIE MASTERS
Title or Position: DIRECTOR
Credential:
Phone: 601-288-4344