Organization
HATTIESBURG CLINIC PA
Active
Other names
Prentiss Family Practice Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN N BATSON MD (EXECUTIVE DIRECTOR)
(601) 268-5601
Entity
Organization
Contact information
Practice address
1014 ROSE STREET, PRENTISS, MS 39474
(601) 792-2071
(601) 792-8134
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5463
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014320
—
MS
Enumeration date
10/05/2006
Last updated
10/07/2020
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