Healthcare Provider Details

I. General information

NPI: 1699152686
Provider Name (Legal Business Name): MATHIOS M BAYSSIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 E COLLEGE ST
PULASKI TN
38478-4541
US

IV. Provider business mailing address

1005 DR. D. B. TODD, JR., BOULEVARD
NASHVILLE TN
37208
US

V. Phone/Fax

Practice location:
  • Phone: 931-363-7531
  • Fax:
Mailing address:
  • Phone: 615-973-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50595
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50595
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57755
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: