Provider Demographics
NPI:1982744348
Name:HATTIESBURG NEONATOLOGY, PLLC
Entity Type:Organization
Organization Name:HATTIESBURG NEONATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-268-5221
Mailing Address - Street 1:5003 HARDY ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1319
Mailing Address - Country:US
Mailing Address - Phone:601-268-5221
Mailing Address - Fax:
Practice Address - Street 1:5003 HARDY ST
Practice Address - Street 2:SUITE 302
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1319
Practice Address - Country:US
Practice Address - Phone:601-268-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0010041012080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114976Medicaid
MS01982035Medicaid
MS1891743928OtherR. ALAN BRINSON, MD - NPI
MS1891743928OtherR. ALAN BRINSON, MD - NPI