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PINE STREET FAMILY MEDICINE
NPI 1578283776
Family Medicine in Hattiesburg, MS

Active since August 30, 2022CLIA 25D2267273 · Certificate of Compliance
908 W PINE ST, HATTIESBURG, MS 39401(601) 268-5850(601) 579-5240 Get Directions Write a Review

NPPES record last updated: August 30, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Pine Street Family Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PINE STREET FAMILY MEDICINE (NPI 1578283776) is a healthcare organization registered as a family medicine in Hattiesburg, Mississippi and active in the NPI registry since August 2022. The organization holds a CLIA Certificate of Compliance certificate valid through May 23, 2027 and lists Bryan N Batson, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1578283776
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameHATTIESBURG CLINIC, PA
Location Address908 W PINE STHattiesburg, MS 39401-4262
Mailing Address415 S 28th AveHattiesburg, MS 39401-7283 · (601) 268-5850 · Fax (601) 579-5240
Phone(601) 268-5850
Fax(601) 579-5240
Organization SubpartNo
Authorized OfficialBryan N BatsonExecutive Director · (601) 264-6000
Enumeration DateAugust 30, 2022
NPPES CertifiedAugust 30, 2022
✔ NPI 1578283776 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
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.
908 W PINE ST, Hattiesburg, MS 39401
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Other Names 1

Doing Business AsPine Street Family Medicine

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 25D2267273

Pine Street Family Medicine · Hattiesburg, MS
Active · expires May 23, 2027
CLIA Number25D2267273
Laboratory TypePhysician Office
Certificate Effective DateMay 24, 2025
Certificate Expiration DateMay 23, 2027
Laboratory DirectorDr. Shomari D. Thompson
Laboratory Phone(601) 579-3022
Laboratory LocationPine Street Family Medicine908 W Pine St, Hattiesburg, MS 39401
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HATTIESBURG CLINIC, PA
Podiatrist
908 W PINE ST
HATTIESBURG, MS 39401
Forrest County (601) 579-3022
MATTHEW DANE BOLTON CNP
Nurse Practitioner
908 W PINE ST
HATTIESBURG, MS 39401
Forrest County (601) 268-5850
CHARLES D HERNANDEZ DO
Internal Medicine
908 W PINE ST
HATTIESBURG, MS 39401
Forrest County (601) 268-5850

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Hattiesburg Clinic, PA's NPI number?

The NPI number for Hattiesburg Clinic, PA is 1578283776. It was assigned to this organization in the NPPES registry on August 30, 2022. The provider is doing business as Pine Street Family Medicine.

Where is Hattiesburg Clinic, PA located?

Hattiesburg Clinic, PA is located at 908 W Pine St, Hattiesburg, MS 39401. The listed phone number is (601) 268-5850.

What is Hattiesburg Clinic, PA's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Hattiesburg Clinic, PA hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 25D2267273) is associated with this NPI, valid through May 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Hattiesburg Clinic, PA was last updated on August 30, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.