Provider Demographics
NPI:1720650237
Name:COPIAH COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:COPIAH COUNTY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KORTNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-574-7200
Mailing Address - Street 1:27190 HWY 28
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083
Mailing Address - Country:US
Mailing Address - Phone:601-574-7200
Mailing Address - Fax:601-643-6009
Practice Address - Street 1:1096 BEECH ST
Practice Address - Street 2:
Practice Address - City:WESSON
Practice Address - State:MS
Practice Address - Zip Code:39191
Practice Address - Country:US
Practice Address - Phone:601-894-2514
Practice Address - Fax:601-643-6009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPIAH COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-14
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty