| Lincoln Road Family Medicine | |
|
4209 Lincoln Road Hattiesburg MS 39402 | |
| (601) 579-5400 | |
| (601) 261-3521 |
| Full Name | Lincoln Road Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 4209 Lincoln Road, Hattiesburg, 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 |
|---|---|
| Lincoln Road Family Medicine 4209 Lincoln Road Family Medicine Hattiesburg MS 39402 Ph: (601) 579-5400 | Lincoln Road Family Medicine 4209 Lincoln Road Hattiesburg MS 39402 Ph: (601) 579-5400 |
| NPI Number | 1588945273 |
|---|---|
| Provider Enumeration Date | 09/08/2011 |
| Last Update Date | 02/18/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588945273 | NPI | - | NPPES |
| 09014185 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 11345 (Mississippi) | Primary |
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