MEDICARE: STAN J MAYS MD A PROFESSIONAL MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	L18505	LA

General Provider Information

NPI Number	:	1104959741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAN J MAYS MD A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	4242 GUS YOUNG AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-1733
Country	:	US
Telephone Number	:	225-926-2258
Fax Number	:	225-925-2520

Provider Business Practice Location Address
First Line	:	4242 GUS YOUNG AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-1733
Country	:	US
Telephone Number	:	225-926-2258
Fax Number	:	225-925-2520

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STAN J MAYS
Credential	:	M.D.
Telephone Number	:	225-926-2258

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	06/16/2011

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