Healthcare Provider Details

I. General information

NPI: 1467706762
Provider Name (Legal Business Name): GREENE COUNTY CLINIC HOSPITAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 JACKSON AVE
LEAKESVILLE MS
39451-9105
US

IV. Provider business mailing address

PO BOX 1007
LUCEDALE MS
39452-1007
US

V. Phone/Fax

Practice location:
  • Phone: 601-947-8181
  • Fax: 601-947-4411
Mailing address:
  • Phone: 601-947-1330
  • Fax: 601-947-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN M RUTLEDGE
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 601-947-1330