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General NPI Number Information
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NPI Number | 1225247505
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Entity Type | Organization
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Legal Business Name | JEFFERSON COUNTY HOSPITAL
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 870 MAIN STREET
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City | FAYETTE
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State | MS
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Zip | 39069
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Country | US
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Telephone | 601-786-3401
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Fax | 601-786-3400
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Provider Business Mailing Address
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Address Line | 870 MAIN STREET
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City | FAYETTE
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State | MS
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Zip | 39069
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Country | US
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Telephone | 601-786-3401
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Fax | 601-786-3400
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JERRY KENNEDY
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Credential |
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Telephone | 601-786-3401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14997
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 16670
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 14721
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 07965
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License Number State | MS
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