Healthcare Provider Details

I. General information

NPI: 1275054579
Provider Name (Legal Business Name): MUHAMMED BILAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 MATTHEW DR STE 5
WAYNESBORO MS
39367-2534
US

IV. Provider business mailing address

940 MATTHEW DR STE 5
WAYNESBORO MS
39367-2534
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-7285
  • Fax: 601-735-7288
Mailing address:
  • Phone: 601-735-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30073
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: