=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346734373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TALLAHATCHIE GENERAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2018
-----------------------------------------------------
Last Update Date | 05/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 W WALNUT ST
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38921-2242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-647-5172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 W WALNUT ST
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38921-2242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-647-5172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RE
-----------------------------------------------------
Name | HEATHER GODSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-625-7191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------