Provider Demographics
NPI:1619931581
Name:BAYSDEN, TERESA J (DO)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:BAYSDEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2421
Mailing Address - Country:US
Mailing Address - Phone:256-259-5313
Mailing Address - Fax:423-495-4970
Practice Address - Street 1:29810 AL HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AL
Practice Address - Zip Code:35958-5240
Practice Address - Country:US
Practice Address - Phone:256-597-4114
Practice Address - Fax:256-597-4115
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057348207Q00000X
TN1949207Q00000X
AL1432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL163444Medicaid
TN1507508Medicaid
TN4125415OtherBLUE CROSS BLUE SHIELD TN
7218773OtherAETNA
GA0105OtherJOHN DEERE HEALTH PLAN
AL51152886OtherBC/BS OF ALABAMA
GA913605OtherBLUE CROSS BLUE SHIELD GA
GA000211956AMedicaid
TN4125415OtherBLUE CROSS BLUE SHIELD TN
TN1507508Medicaid
GA111815Medicare Oscar/Certification
AL102I084986Medicare PIN
GA08CBBMSMedicare PIN