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General NPI Number Information
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NPI Number | 1982836037
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Entity Type | Organization
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Legal Business Name | BETHANY R HAIRSTON MD
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 724 LEIGH DRIVE
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City | COLUMBUS
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State | MS
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Zip | 39705-3098
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Country | US
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Telephone | 662-328-3375
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Fax | 662-328-3395
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Provider Business Mailing Address
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Address Line | 724 LEIGH DRIVE
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City | COLUMBUS
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State | MS
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Zip | 39705-3098
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Country | US
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Telephone | 662-328-3375
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Fax | 662-328-3395
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | BETHANY R HAIRSTON
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Credential | MD
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Telephone | 662-328-3375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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