# WALTHAL RURAL HEALTH CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tylertown Internal Medicine Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144530403
- **Authorized official:** EVAN DILLARD (PRESIDENT/CEO)
- **Authorized official phone:** (601) 288-4490

## Contact information

- **Practice address:** 200 HOSPITAL DR, TYLERTOWN, MS 39667-2020
- **Practice address phone:** (601) 876-5303
- **Mailing address:** PO BOX 677, TYLERTOWN, MS 39667-0677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 10220 | MS | Yes |

## Other

- **Enumeration date:** 10/20/2010
- **Last updated:** 04/11/2013