Provider Demographics
NPI:1104840958
Name:BATSON, BRYAN N (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:N
Last Name:BATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-296-2990
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:1101 S 28TH AVE STE B
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2610
Practice Address - Country:US
Practice Address - Phone:601-296-2990
Practice Address - Fax:601-296-2860
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17166207RH0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08807707Medicaid
LA1419681Medicaid
MS640507572THOtherAMERICAN ADMIN GROUP
LA1419681Medicaid
H58890Medicare UPIN
MS110001636Medicare PIN