NPIMap

Hattiesburg Clinic PA

Organization Active NPI Family Medicine Physician · Purvis, MS

NPI 1124115498 · NPPES record last updated Oct 7, 2020

Key facts

NPI
1124115498
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
HATTIESBURG CLINIC PA
Practice address
101 Weems St
Purvis, MS 39475-4062
Phone
(601) 794-2224
Fax
(601) 794-6392
NPI assigned
Oct 6, 2006
Organization subpart
No

Authorized official

Name
Dr. Bryan N Batson, MD
Title
Executive Director
Phone
(601) 268-5601

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0692132Family Clinic of Purvis
101 Weems Street, Purvis, MS 39475		ComplianceNov 17, 2027

National Provider Directory

Tax ID family
Hattiesburg Clinic PA (136 organizations share this tax ID)

Locations

101 Weems St
Purvis, MS 39475
Phone (601) 794-2224

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

101 Weems St
Purvis, MS 39475-4062

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-5463

Other identifiers

IdentifierTypeStateIssuer
01982768MedicaidMS

Other names

  • The Family Clinic - Purvis Doing business as

Other providers in Purvis, MS

All providers in Purvis, MS · Family Medicine Physician in Mississippi

Sources for this page

Verify at the official NPI Registry.