Healthcare Provider Details

I. General information

NPI: 1619931581
Provider Name (Legal Business Name): TERESA J BAYSDEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29810 AL HIGHWAY 71
BRYANT AL
35958-5240
US

IV. Provider business mailing address

309 TAYLOR ST
SCOTTSBORO AL
35768-2421
US

V. Phone/Fax

Practice location:
  • Phone: 256-597-4114
  • Fax: 256-597-4115
Mailing address:
  • Phone: 256-259-5313
  • Fax: 423-495-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number057348
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1949
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1432
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: