Healthcare Provider Details

I. General information

NPI: 1326600537
Provider Name (Legal Business Name): HAILEY LANE FAIST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 04/03/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INDEPENDENCE
COLUMBUS MS
39710-5285
US

IV. Provider business mailing address

201 INDEPENDENCE
COLUMBUS MS
39710-5300
US

V. Phone/Fax

Practice location:
  • Phone: 662-434-1599
  • Fax:
Mailing address:
  • Phone: 662-434-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101271437
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101271437
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: