Provider Demographics
NPI:1588657274
Name:BATES, JAY NEWTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:NEWTON
Last Name:BATES
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1430 HARPER ST
Mailing Address - Street 2:BUILDING B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-0617
Mailing Address - Country:US
Mailing Address - Phone:706-724-5451
Mailing Address - Fax:706-724-9562
Practice Address - Street 1:1430 HARPER ST
Practice Address - Street 2:BUILDING B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-0617
Practice Address - Country:US
Practice Address - Phone:706-724-5451
Practice Address - Fax:706-724-9562
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2022-08-26
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Provider Licenses
StateLicense IDTaxonomies
GA048471208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG48471Medicaid
GA02BBCRFMedicare PIN
SCG48471Medicaid