Provider Demographics
NPI:1619555471
Name:EUBANKS, HALEIGH BERNICE (DO, PHD)
Entity Type:Individual
Prefix:DR
First Name:HALEIGH
Middle Name:BERNICE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:DO, PHD
Other - Prefix:
Other - First Name:HALEIGH
Other - Middle Name:BERNICE
Other - Last Name:EUBANKS-BAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO, PHD
Mailing Address - Street 1:1304 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2822
Mailing Address - Country:US
Mailing Address - Phone:504-616-6510
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program