# HATTIESBURG CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ophthalmology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053400044
- **Authorized official:** DR. BRYAN N BATSON MD (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (601) 268-5601

## Contact information

- **Practice address:** 415 S 28TH AVE, HATTIESBURG, MS 39401-7246
- **Practice address phone:** (601) 579-5300
- **Practice address fax:** (601) 579-5303
- **Mailing address:** 415 S 28TH AVE, HATTIESBURG, MS 39401-7246
- **Mailing address phone:** (601) 579-5300
- **Mailing address fax:** (601) 579-5302

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/11/2006
- **Last updated:** 10/07/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 04777771 | — | MS |