Healthcare Provider Details

I. General information

NPI: 1629365358
Provider Name (Legal Business Name): JOANNA DIANE BAYLES D,I,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

878 LAKELAND DR
JACKSON MS
39216-4644
US

IV. Provider business mailing address

PO BOX 4999
JACKSON MS
39296-4999
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6800
  • Fax: 601-984-6811
Mailing address:
  • Phone: 601-984-5426
  • Fax: 601-984-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT-2402
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: