Full Name | |
---|---|
Speciality | Family Medicine |
Location | 101 Weems St, Purvis, Mississippi |
Authorized Official Name and Position | Bryan N Batson (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6012685601 |
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 | 101 Weems St Purvis MS 39475-4062 Ph: (601) 794-2224 |
NPI Number | 1124115498 |
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Provider Enumeration Date | 10/06/2006 |
Last Update Date | 10/07/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124115498 | NPI | - | NPPES |
01982768 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |