NPIMap

Organization Active NPI

Hattiesburg Clinic PA

Doing business as Physical Medicine and Rehabilitation

  • Physical Medicine & Rehabilitation Physician
  • Hattiesburg, MS
National Provider Identifier
1205917143
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
HATTIESBURG CLINIC PA
Doing business as
Physical Medicine and Rehabilitation
Practice address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone
(601) 579-5430
Fax
(601) 579-5431
NPI assigned
Oct 18, 2006
Last updated
Oct 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X Primary

Addresses

Primary practice location

415 S 28TH Ave
Hattiesburg, MS 39401-7246

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 268-5630

Other identifiers 1

IdentifierTypeStateIssuer
07581249MedicaidMS

Other names 1

  • Physical Medicine and Rehabilitation Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hattiesburg Clinic PA136 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602028800000",
    "number": "1205917143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-268-5630",
            "fax_number": "601-268-5819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-579-5430",
            "fax_number": "601-579-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A",
        "authorized_official_last_name": "BATSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-268-5601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07581249",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physical Medicine and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Physical Medicine and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.