Hattiesburg Clinic PA
Organization Active NPI Sports Medicine (Preventive Medicine) Physician · Hattiesburg, MS
NPI 1871674754 · NPPES record last updated Feb 23, 2021
Key facts
- NPI
- 1871674754
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Preventive Medicine) Physician 2083S0010X
- Legal business name
- HATTIESBURG CLINIC PA
- Practice address
- 415 S 28TH Ave
Hattiesburg, MS 39401-7246 - Phone
- (601) 579-5406
- Fax
- (601) 268-5756
- NPI assigned
- Oct 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Bryan N Batson
- Title
- Executive Director
- Phone
- (601) 264-6000
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Hattiesburg Clinic PA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Preventive Medicine) Physician |
2083S0010X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06389072 | Medicaid | MS |
Other names
- Sports Medicine
Other providers in Hattiesburg, MS
- Hattiesburg Clinic PA
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- Hattiesburg Clinic PA
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All providers in Hattiesburg, MS · Sports Medicine (Preventive Medicine) Physician 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 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.