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Organization
WALTHALL RURAL HEALTH CLINIC
Active
Organization
WALTHALL RURAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN DILLARD (PRESIDENT/CEO)
(601) 288-7000
Entity
Organization
Contact information
Practice address
200 HOSPITAL DR, TYLERTOWN, MS 39667-2020
(601) 876-5303
(601) 876-0653
Mailing address
POST OFFICE BOX 677, TYLERTOWN, MS 39667-2025
(601) 876-5303
(601) 876-0653
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
11133
MS
207Q00000X
Family Medicine Physician
Primary
13883
MS
207R00000X
Internal Medicine Physician
10220
MS
Other
Enumeration date
09/24/2010
Last updated
05/08/2012
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