Organization
HATTIESBURG CLINIC PA
Active
Other names
Petal Family Practice Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN N BATSON (EXECUTIVE DIRECTOR)
(601) 264-6000
Entity
Organization
Contact information
Practice address
50 PARKWAY LN, PETAL, MS 39465-3035
(601) 544-7404
(601) 584-6457
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 544-7404
(601) 584-6457
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07605763
—
MS
Enumeration date
09/25/2006
Last updated
02/23/2021
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