HATTIESBURG CLINIC PA (NPI# 1497836308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497836308 |
| Entity Type | Organization |
| Organization Name | HATTIESBURG CLINIC PA |
| Other Organization Name | GASTROENTEROLOGY |
| Practice Address |
415 S 28th Ave Hattiesburg MS 39401-7246 |
| Practice Telephone | 6012685680 |
| Practice Fax Number | 6012685778 |
| Mailing Telephone | 6012685680 |
| Mailing Fax Number | 6012685778 |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2013-02-07 |
| 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 | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 06175873 | 05 |
| Other Name | Type Code |
|---|---|
| Gastroenterology | 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 |
415 S 28TH AVE |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-7246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225030372 | Norman Blake Moore Jr. | Nurse Anesthetist, Certified Registered | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2005-06-01 |
| 1457950842 | Tyler Griffin Armstrong | Nurse Anesthetist, Certified Registered | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-10-19 |
| 1538776679 | Hattiesburg Clinic, Pa | Clinic/Center | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-09-23 |
| 1205446804 | Robert Price Ledbetter | Perfusionist | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-08-07 |
| 1972143626 | Jarrod Edward Gant | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7283 | 2020-01-10 |
| 1720625841 | Corey Lyle Gambrell | Nurse Anesthetist, Certified Registered | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-12-09 |
| 1447802103 | Heather Pritchett Bassi | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-07-12 |
| 1891357588 | Dylan Winston Boyd | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-07-02 |
| 1578124186 | Casie Barnes | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-06-25 |
| 1992364491 | Stacy Louise Neames | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7283 | 2019-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558374850 | William M Farmer | Internal Medicine | 100 Methodist Blvd, Hattiesburg, MS 39402-1295 | 2006-08-15 |
| 1740283126 | Stephen E Buckley | Internal Medicine | 100 Methodist Hospital Blvd, Hattiesburg, MS 39402-1295 | 2005-05-31 |
| 1366607749 | Michael Anthony Goebel | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2008-07-24 |
| 1295932168 | Telciane Vesa | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2007-07-02 |
| 1366550758 | Joseph P Phillips | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-08-27 |
| 1750497590 | Gregory R Owens | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-08-22 |
| 1730293234 | Hattiesburg Gi Associates, Pllc | Internal Medicine | 100 Methodist Hospital Blvd, Hattiesburg, MS 39402-1295 | 2006-08-19 |
| 1710997077 | Sean Douglas Fink | Internal Medicine | 415 South 28th Avenue, Hattiesburg, MS 39401-7246 | 2006-08-09 |
| 1134137532 | Everett Howell Crawford Jr. | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-08-03 |
| 1992719777 | Kevin P Blanchard | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-07-28 |
| Find all providers in HATTIESBURG | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
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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.