HATTIESBURG CLINIC PA (NPI# 1316047657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316047657 |
| Entity Type | Organization |
| Organization Name | HATTIESBURG CLINIC PA |
| Other Organization Name | IMMEDIATE CARE - LAUREL |
| Practice Address |
2313 Highway 15 N Laurel MS 39440-1805 |
| Mailing Address |
415 S 28th Ave Hattiesburg MS 39401-7246 |
| Practice Telephone | 6016492775 |
| Practice Fax Number | 6016492686 |
| Mailing Telephone | 6015795463 |
| Mailing Fax Number | 6015795240 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2015-03-31 |
| Authorized Official Name | TOMMY G THORNTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6012685601 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 08154801 | 05 |
| Other Name | Type Code |
|---|---|
| Immediate Care - Laurel | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831251925 | Hattiesburg Clinic Pa | Clinic/Center | 101 Courtenay Cir, Hattiesburg, MS 39402-3153 | 2006-12-14 |
| 1649332735 | Hattiesburg Clinic Pa | Psychologist | 2 Southern Point Pkwy Ste 201, Hattiesburg, MS 39401-8025 | 2006-12-14 |
| 1033270921 | Hattiesburg Clinic Pa | Internal Medicine | 940 Matthew Dr, Waynesboro, MS 39367-2522 | 2006-12-13 |
| 1184785065 | Hattiesburg Clinic Pa | Ophthalmology | 6414 Highway 98 West, Suite 80, Hattiesburg, MS 39402 | 2006-12-13 |
| 1417046574 | Hattiesburg Clinic Pa | Family Medicine | 2013 North Pine, Heidelberg, MS 39439 | 2006-10-12 |
| 1962599282 | Hattiesburg Clinic Pa | Physical Therapist | 206 Corinth Rd, Petal, MS 39465-2883 | 2006-10-06 |
| 1972690287 | Hattiesburg Clinic Pa | Ophthalmology | 321 S 11th Ave, Laurel, MS 39440-4316 | 2006-10-06 |
| 1114014479 | Hattiesburg Clinic Pa | Dermatology | 6 Medical Blvd, Hattiesburg, MS 39401-7230 | 2006-10-06 |
| 1104910322 | Hattiesburg Clinic Pa | Family Medicine | 300 Pine St, Taylorsville, MS 39168-5432 | 2006-10-03 |
| 1730272931 | Hattiesburg Clinic Pa | Family Medicine | 801 Main Ave S, Magee, MS 39111-4102 | 2006-10-02 |
| Street Address |
2313 HIGHWAY 15 N |
| City | LAUREL |
| State | MS |
| Zip Code | 39440-1805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427095579 | Chrystal A Sumrall | Family Medicine | 2313 Highway 15 N, Laurel, MS 39440-1805 | 2006-05-31 |
| 1992058556 | Dylan Paul Wagner | Physician Assistant | 2313 Highway 15 N, Laurel, MS 39440-1805 | 2012-10-19 |
| 1477864585 | Charles Erickson Probst | Family Medicine | 2313 Highway 15 N, Laurel, MS 39440-1805 | 2010-06-24 |
| 1659508612 | Deborah Darlene Stonefield | Nurse Practitioner | 2313 Highway 15 N, Laurel, MS 39440-1805 | 2009-06-17 |
| 1366686354 | Frank Eugene Dement IIi | Pediatrics | 2313 Highway 15 N, Laurel, MS 39440-1805 | 2009-04-22 |
| 1952414583 | Larry T Holifield | Family Medicine | 2313 Highway 15 N, Laurel, MS 39440-1805 | 2006-08-17 |
| 1861417065 | Roger T Lott | Family Medicine | 2313 Highway 15 N, Laurel, MS 39440-1805 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306323159 | Tender Loving Care Homecare LLC | Homemaker | 509 Central Ave Ste 224, Laurel, MS 39440 | 2018-07-24 |
| 1669837910 | Laurel Dental Properties | Dentist | 1925 Pine Belt Drive, Laurel, MS 39440 | 2015-12-30 |
| 1215282991 | South Central Regional Medical Center | Clinic/Center | 525 Wayne Drive, Laurel, MS 39440 | 2012-07-18 |
| 1568721215 | Terry Ratcliff Perkins | Counselor | 5192 Hwy 11 North, Laurel, MS 39440 | 2012-05-15 |
| 1437453057 | Alexander Milne Home for Women | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 616 East 19th Street, Laurel, MS 39440 | 2010-12-23 |
| 1710135629 | Jeffrey R. Moffett | Nurse Practitioner | 3115 Audubon Dr, Laurel, MS 39440 | 2008-09-04 |
| 1003096785 | Family Health Center, Inc | Obstetrics & Gynecology | 103 S. 12th Avenue, Laurel, MS 39440 | 2007-11-09 |
| 1669672143 | Laurel Urology Clinic Pa | Urology | 304 S 10th Ave, Laurel, MS 39440 | 2007-07-23 |
| 1093912370 | Tanweer Hussain Majid | Surgery | 1007 Jefferson Street, Laurel, MS 39440 | 2007-06-29 |
| 1780889923 | Hattiesburg Eye Clinic, Pa | Ophthalmology | 1431 North 10th St, Suite 1, Laurel, MS 39440 | 2007-06-18 |
| Find all providers in zip 39440 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407499452 | Julius Atemafac | Family Medicine | 13944 Baltimore Ave Ste 102, Laurel, MD 20707-5000 | 2019-10-22 |
| 1679050462 | Nicole K Dennis | Family Medicine | 9260 Canterbury Riding, Laurel, MD 20723-1425 | 2018-07-24 |
| 1073051892 | Carol Richardson | Family Medicine | 103 S 12th Ave, Laurel, MS 39440-4322 | 2017-02-01 |
| 1558713511 | Calhoun Medical Clinic, LLC | Family Medicine | 5135 Hwy 84w, Laurel, MS 39443 | 2016-07-01 |
| 1700215399 | Komal A Malik, Md, PC | Family Medicine | 8315 Cherry Ln, Laurel, MD 20707-4830 | 2013-11-05 |
| 1982998209 | Sarah Zaheer | Family Medicine | Centennial Medical Group, 10981 Johns Hopkins Road, Laurel, MD 20723 | 2011-06-03 |
| 1073832044 | Kaveh Sadeghi | Family Medicine | 14113 Baltimore Ave Ste A, Laurel, MD 20707 | 2010-05-28 |
| 1730339995 | Komal A. Malik | Family Medicine | 8315 Cherry Lane, Laurel, MD 20707 | 2008-09-24 |
| 1427218577 | Samuel J. Recob | Family Medicine | 218 E 2nd St, Laurel, NE 68745-1989 | 2008-06-12 |
| 1730204256 | Joyce E. Stout, Md, Pa | Family Medicine | 116 E Front St Ste C, Laurel, DE 19956-1722 | 2007-03-21 |
| Find all providers in LAUREL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.