Provider Demographics
NPI:1487666061
Name:HATTEN, LEWIS E (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:E
Last Name:HATTEN
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 SOUTH 28TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401
Mailing Address - Country:US
Mailing Address - Phone:601-579-5010
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-579-5010
Practice Address - Fax:601-579-3067
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS056192086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00012631Medicaid
LA1500747Medicaid
MS640507572XYOtherAMERICAN ADMIN GROUP
MS640507572XYOtherAMERICAN ADMIN GROUP
MS00012631Medicaid
LA1500747Medicaid