Provider Demographics
NPI:1326120056
Name:FERGUSON, BAILEY JOE (MD)
Entity Type:Individual
Prefix:DR
First Name:BAILEY
Middle Name:JOE
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HICKORY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-9795
Mailing Address - Country:US
Mailing Address - Phone:601-924-9294
Mailing Address - Fax:601-924-7551
Practice Address - Street 1:300 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3665
Practice Address - Country:US
Practice Address - Phone:601-849-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS118212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119322Medicaid
MS00119322Medicaid
E88028Medicare UPIN