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NPI Code Detail

MEDICARE: HATTIESBURG CLINIC, PA

MEDICARE: HATTIESBURG CLINIC, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

General Provider Information

NPI Number : 1427417724
Entity Type Code : Organization
Provider Name (Legal Business Name) : HATTIESBURG CLINIC, PA
Provider Business Mailing Address
First Line : 415 S 28TH AVE
Second Line :
City : HATTIESBURG
State : MS
Zip : 39401-7246
Country : US
Telephone Number : 601-579-5463
Fax Number : 601-579-5240
Provider Business Practice Location Address
First Line : 3 THOMPSON PARK
Second Line :
City : HATTIESBURG
State : MS
Zip : 39401-8202
Country : US
Telephone Number : 601-579-3130
Fax Number : 601-544-3688
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : BRYAN N BATSON
Credential : MD
Telephone Number : 601-264-6000
Provider Enumeration Date : 02/15/2016
Last Update Date : 02/18/2021

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Directions to “HATTIESBURG CLINIC, PA ” Practice Location

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