=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518175314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HATTIESBURG CLINIC, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 02/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 S 28TH AVE
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39401-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-268-5640
-----------------------------------------------------
Fax | 601-261-3507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 S 28TH AVE
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39401-7246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-268-5640
-----------------------------------------------------
Fax | 601-261-3507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | BATSON N BATSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 601-264-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------