Provider Demographics
NPI:1093109316
Name:LAY, JUSTIN M (DO)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:LAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1867 CRANE RIDGE DR., STE 101B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-362-8776
Mailing Address - Fax:601-709-8501
Practice Address - Street 1:7726 OLD CANTON ROAD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-362-8776
Practice Address - Fax:601-856-0181
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MS25783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program