Healthcare Provider Details

I. General information

NPI: 1104840958
Provider Name (Legal Business Name): BRYAN N BATSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S 28TH AVE STE B
HATTIESBURG MS
39402-2610
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-296-2990
  • Fax: 601-296-2860
Mailing address:
  • Phone: 601-296-2990
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number17166
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: