Healthcare Provider Details

I. General information

NPI: 1811302995
Provider Name (Legal Business Name): HATTIESBURG CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S 28TH AVE SUITE 120
HATTIESBURG MS
39401-7206
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-579-5100
  • Fax: 601-579-3211
Mailing address:
  • Phone: 601-579-5463
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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