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General NPI Number Information
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NPI Number | 1386213957
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Entity Type | Organization
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Legal Business Name | HATTIESBURG CLINIC, PA
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 201A BAY AVE
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City | RICHTON
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State | MS
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Zip | 39476-9671
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Country | US
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Telephone | 601-583-1559
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Fax | 601-583-1573
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Provider Business Mailing Address
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Address Line | 415 S 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7246
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Country | US
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Telephone | 601-579-5463
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Fax | 601-579-5240
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Authorized Official
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Title or Position | CEO
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Name | BRYAN N BATSON
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Credential | MD
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Telephone | 601-264-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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