Healthcare Provider Details

I. General information

NPI: 1568557320
Provider Name (Legal Business Name): MISSISSIPPI STATE HOSPITAL AT WHITFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 HWY 468 WEST
WHITFIELD MS
39193-0157
US

IV. Provider business mailing address

P.O. BOX 1 FISCAL SERVICES 3550 HWY 468 WEST
WHITFIELD MS
39193-0157
US

V. Phone/Fax

Practice location:
  • Phone: 601-351-8000
  • Fax: 601-351-8586
Mailing address:
  • Phone: 601-351-8000
  • Fax: 601-351-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31-320
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31-320
License Number StateMS

VIII. Authorized Official

Name: MR. JAMES G CHASTAIN
Title or Position: DIRECTOR
Credential:
Phone: 601-351-8000