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General NPI Number Information
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NPI Number | 1326120056
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Entity Type | Individual
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Provider Name | BAILEY JOE FERGUSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 300 3RD AVE SE
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City | MAGEE
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State | MS
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Zip | 39111-3665
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Country | US
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Telephone | 601-849-7312
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Fax |
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Provider Business Mailing Address
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Address Line | 104 HICKORY HILLS DR
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City | CLINTON
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State | MS
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Zip | 39056-9795
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Country | US
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Telephone | 601-924-9294
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Fax | 601-924-7551
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 11821
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License Number State | MS
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