# NESHOBA COUNTY GENERAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Todd Willis Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750686341
- **Authorized official:** MR. LAWRENCE GRAEBER (CEO)
- **Authorized official phone:** (601) 663-1360

## Contact information

- **Practice address:** 1001 HOLLAND AVE, SUITE 4, PHILADELPHIA, MS 39350-2161
- **Practice address phone:** (601) 656-0010
- **Mailing address:** 1001 HOLLAND AVE, PO BOX 976, PHILADELPHIA, MS 39350-2161
- **Mailing address phone:** (601) 656-0010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/13/2011
- **Last updated:** 01/13/2011