Organization · NPI-2

Hattiesburg Clinic PA

Clinical Medical Laboratory · Hattiesburg, MS

NPI number1053493460
StatusActive
Last updated in NPPESOct 7, 2020

Details

NPI
1053493460
Entity type
Organization (NPI-2)
Legal business name
Hattiesburg Clinic PA
Organization subpart
No
Enumeration date
Oct 19, 2006
Certification date
Oct 7, 2020
Last updated
Oct 7, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
291U00000X Clinical Medical Laboratory––Yes

Other names

  • Clinical Laboratory (Doing Business As)

Practice location

415 S 28th Ave
Hattiesburg, MS 39401-7246

Phone 601-268-5735 · Fax 601-268-5852

Mailing address

415 S 28th Ave
Hattiesburg, MS 39401-7246

Phone 601-579-5488 · Fax 601-579-5240

Authorized official

Bryan N Batson
Executive Director
6012685601

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