MEDICARE: A KEITH LAY JR MD

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1518075720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A KEITH LAY JR MD

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:	433 HWY 18
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-0549
Country	:	US
Telephone Number	:	601-764-2155
Fax Number	:	601-764-9667

Provider Business Practice Location Address
First Line	:	27 S SIXTH ST
Second Line	:
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-9052
Country	:	US
Telephone Number	:	601-764-2143
Fax Number	:	601-764-4890

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MARSHA G LAY
Credential	:	AUTHORIZED OFFICIAL
Telephone Number	:	601-670-6295

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	02/12/2019

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