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102 Shelby Speights Dr Purvis MS 39475-4151 | |
(601) 794-8065 | |
(601) 794-5650 |
Full Name | |
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Speciality | Family Medicine |
Location | 102 Shelby Speights Dr, Purvis, 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 |
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415 S 28th Ave Hattiesburg MS 39401-7246 Ph: (601) 579-5463 | 102 Shelby Speights Dr Purvis MS 39475-4151 Ph: (601) 794-8065 |
NPI Number | 1265532584 |
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Provider Enumeration Date | 09/25/2006 |
Last Update Date | 02/18/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265532584 | NPI | - | NPPES |
1527661 | Medicaid | LA | |
09013970 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |