Provider Demographics
NPI:1649294042
Name:NOYES, TIMOTHY LEE (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEE
Last Name:NOYES
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 1:401 ALCORN DR
Mailing Address - Street 2:STE 2C
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9073
Mailing Address - Country:US
Mailing Address - Phone:662-287-6999
Mailing Address - Fax:662-287-1709
Practice Address - Street 1:2000 SHILOH ROAD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-2909
Practice Address - Country:US
Practice Address - Phone:662-287-6999
Practice Address - Fax:662-287-1709
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119927Medicaid
G79758Medicare UPIN
MS110001864Medicare ID - Type Unspecified