Healthcare Provider Details

I. General information

NPI: 1033360565
Provider Name (Legal Business Name): TEJAY WAYNE BARTON HS2
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOUTH BROAD ST.
MOBILE AL
36615
US

IV. Provider business mailing address

7357 BUCKWHEAT TREE RD
VANCLEAVE MS
39565-5060
US

V. Phone/Fax

Practice location:
  • Phone: 251-441-6240
  • Fax: 125-144-1549
Mailing address:
  • Phone: 251-441-6240
  • Fax: 251-441-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: