Full Name | |
---|---|
Speciality | Family Medicine |
Location | 50 Parkway Ln, Petal, Mississippi |
Authorized Official Name and Position | Bryan N Batson (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6012646000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
415 S 28th Ave Hattiesburg MS 39401-7246 Ph: (601) 579-5463 | 50 Parkway Ln Petal MS 39465-3035 Ph: (601) 705-2897 |
NPI Number | 1497162234 |
---|---|
Provider Enumeration Date | 07/14/2014 |
Last Update Date | 02/18/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497162234 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |