Organization Name: | HATTIESBURG CLINIC, P.A |
NPI Number: | 1982649620 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TOMMY G THORNTON (EXECUTIVE DIRECTOR) |
Mailing Address: | 21 Emu Lane Silver Creek |
State: | MS US |
Postal Code: | 39663 |
Phone Number: | 6018860072 |
Fax Number: | 6018860106 |
NPI Enumeration Date: | 06/17/2006 |
NPI Last Update Date: | 08/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |