Healthcare Provider Details

I. General information

NPI: 1780694083
Provider Name (Legal Business Name): TERALD OTIS BAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 HIGHWAY 43 SOUTH STE D
CANTON MS
39046
US

IV. Provider business mailing address

1883 HIGHWAY 43 SOUTH STE D
CANTON MS
39046
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-8992
  • Fax: 601-855-5265
Mailing address:
  • Phone: 601-859-8992
  • Fax: 601-855-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06976
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number06976
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: