Healthcare Provider Details

I. General information

NPI: 1477482008
Provider Name (Legal Business Name): HAYS ROTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

802 LAKELAND DR APT 250
JACKSON MS
39216-4623
US

V. Phone/Fax

Practice location:
  • Phone: 662-816-8722
  • Fax:
Mailing address:
  • Phone: 662-816-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: