HATTIESBURG CLINIC, PA (NPI# 1679053979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679053979 |
| Entity Type | Organization |
| Organization Name | HATTIESBURG CLINIC, PA |
| Other Organization Name | SOUTH 28TH AVENUE FAMILY MEDICINE |
| Practice Address |
South 28th Avenue Family Medicine 1101 South 28th Avenue, Suite C Hattiesburg MS 39402 |
| Mailing Address |
415 S 28th Ave Hattiesburg MS 39401-7246 |
| Practice Telephone | 6012611670 |
| Practice Fax Number | 6015795240 |
| Mailing Telephone | 6012611670 |
| Mailing Fax Number | 6015795463 |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2018-08-16 |
| Authorized Official Name | TOMMY G THORNTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6015795340 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| South 28th Avenue Family 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 |
| 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 |
| 1821021155 | Hattiesburg Clinic, Pa | Clinic/Center | 4820 Plaza Dr, Tylertown, MS 39667-9221 | 2006-07-09 |
| Street Address |
SOUTH 28TH AVENUE FAMILY MEDICINE 1101 SOUTH 28TH AVENUE, SUITE C |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518572965 | Resilient Therapy and Solutions, Pllc | Clinic/Center | 5266 Old Hwy 11 Ste 50, #308, Hattiesburg, MS 39402 | 2020-09-12 |
| 1932710225 | Jones County Medical Supplies, Inc | Durable Medical Equipment & Medical Supplies | 6424 Hwy 98 West, Suite 20, Hattiesburg, MS 39402 | 2020-08-11 |
| 1467086736 | Elizabeth A. Perry | Technician | 1220 Marrie St, Hattiesburg, MS 39402 | 2020-02-26 |
| 1225678063 | Connor Gregory Galloway | Physical Therapist | 3688 Veteran Memorial Drive, Hattiesburg, MS 39402 | 2020-01-09 |
| 1487291456 | Megan Marie Smith | Social Worker | 11 Woodstone Plaza, Hattiesburg, MS 39402 | 2019-12-09 |
| 1821656612 | Julie Covington Mcmahan | Dentist | 100 Madison Plaza, Hattiesburg, MS 39402 | 2019-06-05 |
| 1295392074 | Hattiesburg Clinic, Pa | Preventive Medicine | 6414 Highway 98, Suite 120, Hattiesburg, MS 39402 | 2019-05-28 |
| 1760945356 | Rachandeep Chahal | Student in an Organized Health Care Education/Training Program | 5001 Hardy Street Merit Health Wesley, Hattiesburg, MS 39402 | 2019-04-10 |
| 1386101137 | Courtney L Smith | Behavior Technician | 32 Millbanch Road, Suite 40, Hattiesburg, MS 39402 | 2019-02-28 |
| 1891269940 | Amanda Laine Mcarthur-macisaac | Registered Nurse | 5909 Highway 49 South, Suite 30, Hattiesburg, MS 39402 | 2019-01-11 |
| Find all providers in zip 39402 | ||||
| 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 |
|---|---|---|---|---|
| 1699267625 | Forrest County General Hospital | Family Medicine | 415 S 28th Ave Fl 1, Hattiesburg, MS 39401-7246 | 2018-06-05 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1316390289 | Jenisus Marie Owens | Family Medicine | 5909 U S Highway 49 Ste 20, Hattiesburg, MS 39402-2860 | 2016-07-15 |
| 1760877948 | Jason Fisher | Family Medicine | 1101 S 28th Ave Ste C, Hattiesburg, MS 39402 | 2015-04-03 |
| 1871829929 | Adeline After-hour Care, LLC | Family Medicine | 1307 Adeline St, Hattiesburg, MS 39401-5028 | 2009-10-26 |
| 1366691644 | Stephen Marc Wascomb | Family Medicine | 2556 Old Highway 24, Hattiesburg, MS 39402-8311 | 2008-09-11 |
| 1396902409 | Tonya G Creech | Family Medicine | 3700 Hardy St Ste 10, Hattiesburg, MS 39402-1614 | 2008-05-19 |
| 1265631907 | Ikechukwu Okorie | Family Medicine | 908 W Pine St, Hattiesburg, MS 39401-4262 | 2007-07-13 |
| 1740374255 | Stephen Massey | Family Medicine | 6600 Us Hwy 98, Suite B, Hattiesburg, MS 39402 | 2006-10-02 |
| 1720188030 | Hattiesburg Clinic Pa | Family Medicine | 7148 Us Highway 98, Suite101, Hattiesburg, MS 39402-8446 | 2006-09-25 |
| Find all providers in HATTIESBURG | ||||
| City | HATTIESBURG |
| Zip Code | 39402 |
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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.