Hattiesburg Community Dental Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Hattiesburg, MS
NPI 1366468266 · NPPES record last updated Feb 6, 2026
Key facts
- NPI
- 1366468266
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- HATTIESBURG COMMUNITY DENTAL CENTER
- Practice address
- 68 Old Airport Rd
Hattiesburg, MS 39401-8382 - Phone
- (601) 583-4800
- Fax
- (601) 584-7769
- NPI assigned
- Jul 14, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC
Authorized official
- Name
- Janice Robinson
- Title
- Ceo
- Phone
- (601) 545-8700
Corporate family (same tax ID) 24
Practitioners 64
-
Johanna M Alvarez, MSN, FNP-BC
-
Trish Anne Brix-Baskin, LCSW
-
Brandon L Coleman, D. O.
-
Patricia M Curb-Varnado, LCSW
-
Charles F Diamond, FNP-BC
-
Ronda Carol Eason-Hinton, FNP-BC
-
Anny S Evans, NP
-
Melanie Lynn Frierson, FNP-C
-
Lauren O'Neal Garner, FNP-C
-
Allison Garrett, NP
-
Melissa Dawn Gaspar, APRN, CNM, FNP-C
-
Susan E Gentry, FNP
-
Samantha Givens, NP
-
Jennifer Ross Goodwin, PNP-PC
-
Stephanie L Green, CFNP
-
Rasheeda Crowell Hall, M.D.
-
Joshua Peter Hand, M.D.
-
Aspen Hardges, LCSW
-
Charlene Hicks, NP
-
Michelle E Howard, LCSW
-
Charlotte Denise Jordan, MSN, FNP-C
-
Keith A Kersten, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Federally qualified health center certification: CCN 251174
- Legal name
- SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
- Doing business as
- HATTIESBURG COMMUNITY DENTAL CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 4, 2025
- Last certification
- Sep 4, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 68 Old Airport Rd
Hattiesburg, MS 39401-8382
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Larry Davis |
Corporate Director |
Mar 23, 2021 | |
| Deborah Gambrell |
Corporate Director |
Jun 27, 2023 | |
| Karen Speed |
Corporate Director |
Jun 29, 2004 | |
| Sherlita Babineaux |
Corporate Director |
Oct 31, 2023 | |
| Nanni Freeman |
Corporate Director |
Apr 26, 2005 | |
| Maxine Bolton |
Corporate Director |
Oct 28, 2014 | |
| Janice Robinson |
Corporate Officer |
Jan 23, 2023 | 100% |
| Corporate Director |
Jan 23, 2023 | ||
| W-2 Managing Employee |
Jan 23, 2023 | 100% | |
| Virginia Burks |
Corporate Director |
Jan 1, 1995 | |
| Joyce Woullard |
Corporate Director |
Sep 26, 1995 | |
| Derrick Autmon |
Corporate Director |
Jun 23, 2015 | |
| Terry King |
Corporate Director |
Jun 27, 2023 |
All facility ownership & control disclosures 37
| Facility | Type | Role | Since |
|---|---|---|---|
| Hattiesburg Public School and Community Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Woodley Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Hattiesburg High School and Community Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| N. R. Burger School and Community Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Minor Care Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Picayune Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Lumberton Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Brooklyn Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| New Augusta Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Women'S Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Hattiesburg Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Seminary Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Petal Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Petal Primary School |
Federally qualified health center | Operational/Managerial Control (100%) | May 29, 1979 |
| Petal Upper Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Petal Middle School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Petal High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Hattiesburg High School Campus |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Petal School Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Semrhi Support Service Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Forrest County Agricultural High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Baxterville School (K -8) |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Purvis Lower Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Oak Grove Longleaf |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Purvis High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 14, 2022 |
| Sumrall Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Lamar County School Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Oak Grove Elementary |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Sumrall High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Sumrall Middle School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Purvis Middle School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Oak Grove High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Oak Grove Middle School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Lumberton Elementary |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Purvis Upper Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Lumberton High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Bellevue Elementary |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250909000157 | MS | Part a Provider - Federally Qualified Health Center (FQHC) | 2466342605 | Practice locations: Hattiesburg, MS |
National Provider Directory
- Tax ID family
- Seminary Clinic
- Part of
- Seminary Clinic
Locations
401 S Dogwood Ave
Collins, MS 39428
Phone (601) 765-4383
1208 S Dogwood Ave
Collins, MS 39428
Phone 60154587002217
824 Hopewell Rd
Collins, MS 39428
Phone (601) 765-8568
6071 U S Highway 49
Ste 205
Hattiesburg, MS 39401
Phone (601) 264-1500
316 Travillion Rd
Hattiesburg, MS 39401
Phone (601) 584-9303
610 Dumas Ave
Hattiesburg, MS 39401
Phone (601) 584-6311
222 S 27th Ave
Hattiesburg, MS 39401
Phone (601) 450-3030
200 W Main St
Seminary, MS 39479
Phone (601) 722-3220
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | MS | Yes |
Addresses
Primary practice location
68 Old Airport Rd
Hattiesburg, MS 39401-8382
Mailing address
PO Box 1729
Hattiesburg, MS 39403-1729
Phone (601) 545-8700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2704503 | Other | MS | MS UNITED HEALTH CARE |
| 009015171 | Medicaid | MS |
Other names
- Hattiesburg Community Dental Center
Other providers in Hattiesburg, MS
- Hattiesburg Clinic, PA
- Hattiesburg Clinic, PA
- Hattiesburg Clinic, PA
- Hattiesburg Clinic, PA
- Hattiesburg Clinic, PA
- Hattiesburg Convalescent Home, Inc.
- Hattiesburg Convalescent Home, Inc.
- Hattiesburg Eye Clinic Cataract & Lasik Surgery Center, LLC
- Hattiesburg Eye Clinic Cataract & Lasik Surgery Center, LLC
- Hattiesburg Eye Clinic, P.a.
All providers in Hattiesburg, MS · Federally Qualified Health Center (FQHC) in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.