Healthcare Provider Details

I. General information

NPI: 1912148958
Provider Name (Legal Business Name): TANISHA HAYES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2009
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 TUSCAN AVE WILLIAM CAREY UNIVERSITY-COM BOX 197
HATTIESBURG MS
39401-5461
US

IV. Provider business mailing address

498 TUSCAN AVE WILLIAM CAREY UNIVERSITY-COM BOX 207
HATTIESBURG MS
39401-5461
US

V. Phone/Fax

Practice location:
  • Phone: 601-318-6749
  • Fax: 601-318-6032
Mailing address:
  • Phone: 601-318-6749
  • Fax: 601-318-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberOT012229
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number0102202723
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0102202723
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: