Basic Information
| Provider Information | |||||||||
| NPI: | 1104840958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BATSON | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 S 28TH AVE | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394017246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012962990 | ||||||||
| FaxNumber: | 6015795240 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 S 28TH AVE STE B | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394022610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012962990 | ||||||||
| FaxNumber: | 6012962860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0005X | 17166 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hypertension Specialist |
ID Information
| ID | Type | State | Issuer | Description | 08807707 | 05 | MS | MEDICAID | 1419681 | 05 | LA | MEDICAID | 640507572TH | 01 | MS | AMERICAN ADMIN GROUP | OTHER |