Provider Demographics
NPI:1952366114
Name:BAYANI, AYN VINCENT DEJESUS (MD)
Entity Type:Individual
Prefix:
First Name:AYN VINCENT
Middle Name:DEJESUS
Last Name:BAYANI
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:PO BOX 16190
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-6190
Mailing Address - Country:US
Mailing Address - Phone:478-275-0792
Mailing Address - Fax:478-275-0713
Practice Address - Street 1:200 FAIRVIEW PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2547
Practice Address - Country:US
Practice Address - Phone:478-275-0792
Practice Address - Fax:478-275-0713
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055470207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA555475686AMedicaid
GAP00200156OtherRR MEDICARE
GA0868802730OtherCHAMPUS
GA555475686BMedicaid
GA161839OtherBCBS
GAG84260Medicare UPIN
GA555475686AMedicaid
GA555475686BMedicaid