Organization
HATTIESBURG CLINIC, PA
Active
Other names
Pearl River Dialysis Unit
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN N BATSON MD (EXECUTIVE DIRECTOR)
(601) 264-6000
Entity
Organization
Contact information
Practice address
1835 COOPER RD, PICAYUNE, MS 39466-2838
(601) 798-8951
(601) 798-6939
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 798-8951
(601) 798-6939
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050280
BLUE CROSS BLUE SHIELD MS
MS
05
—
00020345
—
MS
01
—
5000477
UNITED HEALTHCARE
MS
Enumeration date
07/09/2006
Last updated
02/18/2021
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