NPIMap

Organization Active NPI

Hattiesburg Clinic, PA

Doing business as Plastic & Reconstructive Surgery

  • Plastic Surgery Physician
  • Hattiesburg, MS
National Provider Identifier
1720177728
Registry record updated Jul 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
HATTIESBURG CLINIC, PA
Doing business as
Plastic & Reconstructive Surgery
Practice address
1 Lincoln Pkwy Ste 200
Hattiesburg, MS 39402-3261
Phone
(601) 261-3690
Fax
(601) 261-3684
NPI assigned
Oct 11, 2006
Last updated
Jul 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2026

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) 264-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X NU Primary

Addresses

Primary practice location

1 Lincoln Pkwy Ste 200
Hattiesburg, MS 39402-3261

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 261-3690

Other identifiers 1

IdentifierTypeStateIssuer
200013960MedicaidMS

Other names 1

  • Plastic & Reconstructive Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040528000685 MS Part B Supplier - Clinic/Group Practice 5193706794 Receives reassigned benefits from 699 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

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

Locations

1 Lincoln Pkwy
Ste 200
Hattiesburg, MS 39402

421 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 268-5640

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783555200000",
    "number": "1720177728",
    "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": "601-261-3690",
            "fax_number": "601-261-3684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LINCOLN PKWY STE 200",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023261",
            "telephone_number": "601-261-3690",
            "fax_number": "601-261-3684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "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": "601-264-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200013960",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plastic & Reconstructive Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Plastic & Reconstructive Surgery",
            "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 Jul 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.