HATTIESBURG CLINIC, PA (NPI# 1407470990) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407470990 |
| Entity Type | Organization |
| Organization Name | HATTIESBURG CLINIC, PA |
| Other Organization Name | HATTIESBURG CLINIC TATUM PARK |
| Practice Address |
103 Medical Park Hattiesburg MS 39401-9042 |
| Mailing Address |
415 S 28th Ave Hattiesburg MS 39401-7246 |
| Practice Telephone | 6012685757 |
| Practice Fax Number | 6015795220 |
| Mailing Telephone | 6015795463 |
| Mailing Fax Number | 6015795240 |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2020-06-09 |
| Authorized Official Name | TOMMY G THORNTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6012646000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Other Name | Type Code |
|---|---|
| Hattiesburg Clinic Tatum Park | Doing Business As Name - Organization |
| Tatum Park Orthopedics and Sports Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295392074 | Hattiesburg Clinic, Pa | Preventive Medicine | 6414 Highway 98, Suite 120, Hattiesburg, MS 39402 | 2019-05-28 |
| 1679053979 | Hattiesburg Clinic, Pa | Family Medicine | South 28th Avenue Family Medicine, 1101 South 28th Avenue, Suite C, Hattiesburg, MS 39402 | 2018-08-16 |
| 1750882080 | Hattiesburg Clinic, Pa | Physical Medicine & Rehabilitation | 2 Southern Point Pkwy Ste 200, Hattiesburg, MS 39401-8025 | 2018-02-22 |
| 1801310768 | Hattiesburg Clinic, Pa | Clinic/Center | 5909 Hwy 49 S, Suite 14, Hattiesburg, MS 39402-2860 | 2017-08-01 |
| 1346780681 | Hattiesburg Clinic, Pa | Family Medicine | 202 E Main Ave, Lumberton, MS 39455-2608 | 2017-03-06 |
| 1356781082 | Hattiesburg Clinic, Pa | Family Medicine | 6941 Highway 11 N, Suite A, Carriere, MS 39426-7793 | 2013-06-26 |
| 1689830549 | Hattiesburg Clinic, Pa | Physical Therapist | 1403 S Main St Ste E, Poplarville, MS 39470-3394 | 2008-07-31 |
| 1841494895 | Hattiesburg Clinic, Pa | Clinic/Center | 103 Asbury Cir, Hattiesburg, MS 39402-1302 | 2007-06-13 |
| 1669405981 | Hattiesburg Clinic, Pa | Clinic/Center | 14 Bay Ave, Bay Springs, MS 39422-9206 | 2006-07-09 |
| 1245263540 | Hattiesburg Clinic, Pa | Clinic/Center | 1527 Larry Dr, Laurel, MS 39440-1932 | 2006-07-09 |
| Street Address |
103 MEDICAL PARK |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-9042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821102740 | Robert Clint Hudson | Physical Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2006-08-18 |
| 1811548696 | Lauren Mckenzy Reynolds | Physical Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2019-09-24 |
| 1962051946 | John Reynolds Clark | Physical Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2019-09-11 |
| 1821655150 | Nancy Danielle Lewis | Physical Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2019-05-22 |
| 1255869665 | Jennifer Lacroix Gunther | Nurse Practitioner | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2017-05-30 |
| 1518347681 | John Michael Porter | Occupational Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2015-06-04 |
| 1306254255 | Jessica Mccallister Tullos | Emergency Medicine | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2014-07-23 |
| 1063848075 | Rowdy Chance Lee | Physician Assistant | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2013-09-23 |
| 1144517822 | Jeremy Blake Wells | Family Medicine | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2011-07-01 |
| 1689908352 | Shawn Fayard | Specialist/Technologist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2009-09-28 |
| 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 | 225100000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT’s assess joint motion, muscle strength and endurance, function of heart and lungs, and performance of activities required in daily living, among other responsibilities. Treatment includes therapeutic exercises, cardiovascular endurance training, and training in activities of daily living. (2) A physical therapist is a person qualified by an accredited program in physical therapy, licensed by the state, and practicing within the scope of that license. Physical therapists treat disease, injury, or loss of a bodily part by physical means, such as the application of light, heat, cold, water, electricity, massage and exercise. They develop treatment plans based upon each patient’s strengths, weaknesses, range of motion and ability to function. (3) A health professional who specializes in physical therapy- the health care field concerned primarily with the treatment of disorders with physical agents and methods, such as massage, manipulation, therapeutic exercises, cold, heat (including short-wave, microwave, and ultrasonic diathermy), hydrotherapy, electric stimulation and light to assist in rehabilitating patients and in restoring normal function after an illness or injury. |
| Notes: Source: (1) APTA Guidelines for Physical Therapy Claims Review, American Physical Therapy Association. (3) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780214098 | Sean James Hodges | Physical Therapist | 6059 U S Highway 98 Ste 50, Hattiesburg, MS 39402-9456 | 2020-01-26 |
| 1225678063 | Connor Gregory Galloway | Physical Therapist | 3688 Veteran Memorial Drive, Hattiesburg, MS 39402 | 2020-01-09 |
| 1871062364 | Melanie Lane | Physical Therapist | 29 Park Pl Apt 1402, Hattiesburg, MS 39402-5902 | 2018-11-14 |
| 1104317213 | Zachary Bruce Kulzer | Physical Therapist | 7148 Highway 98 West, Suite 102, Hattiesburg, MS 39402 | 2018-05-24 |
| 1285160648 | Ty O'keith Ashley | Physical Therapist | 427 S 15th Ave, Hattiesburg, MS 39401-6248 | 2017-05-04 |
| 1528307469 | Stephen A Worrel Jr. | Physical Therapist | 3906 Hardy St # 15, Hattiesburg, MS 39402-1683 | 2013-02-13 |
| 1851656268 | Victoria Michelle Honeysucker | Physical Therapist | 727 Grace Ave, Hattiesburg, MS 39401-2927 | 2012-07-11 |
| 1811297120 | Jeremy A Bennett | Physical Therapist | 7127 Highway 98 West, Suite 40, Hattiesburg, MS 39402 | 2010-11-02 |
| 1891007522 | Tommie J Williamson Shappley | Physical Therapist | 48 Pleasant Pond Loop, Hattiesburg, MS 39402-8253 | 2010-07-10 |
| 1225258494 | Kimberly Gardner Tatum | Physical Therapist | 104 Silver Point Lane, Hattiesburg, MS 39402 | 2007-04-27 |
| 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.