1952366114 NPI number — AYN VINCENT DEJESUS BAYANI M.D.

Table of content: AYN VINCENT DEJESUS BAYANI M.D. (NPI 1952366114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952366114 NPI number — AYN VINCENT DEJESUS BAYANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAYANI
Provider First Name:
AYN VINCENT
Provider Middle Name:
DEJESUS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952366114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31040-6190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-275-0792
Provider Business Mailing Address Fax Number:
478-275-0713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 FAIRVIEW PARK DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31021-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-275-0792
Provider Business Practice Location Address Fax Number:
478-275-0713
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  055470 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 055470 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 555475686A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00200156 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0868802730 . This is a "CHAMPUS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 555475686B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161839 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com