Healthcare Provider Details

I. General information

NPI: 1952334260
Provider Name (Legal Business Name): HATTIESBURG CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 HIGHWAY 98 BYP
COLUMBIA MS
39429-3703
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-731-1234
  • Fax: 601-731-2952
Mailing address:
  • Phone: 601-731-6305
  • Fax: 601-731-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN N BATSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-264-6000