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General NPI Number Information
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NPI Number | 1093109316
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Entity Type | Individual
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Provider Name | JUSTIN M. LAY D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 161 MONTGOMERY ST STE D
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City | MADISON
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State | MS
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Zip | 39110-1118
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Country | US
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Telephone | 769-300-5200
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Fax | 601-623-4300
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Provider Business Mailing Address
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Address Line | 161 MONTGOMERY ST STE D
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City | MADISON
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State | MS
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Zip | 39110-1118
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Country | US
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Telephone | 769-300-5220
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Fax | 601-623-4300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25783
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License Number State | MS
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