Individual
WAYNESHA E BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
702 MARTIN LUTHER KING ST, MOUND BAYOU, MS 38762-9314
(662) 741-8800
Mailing address
702 MARTIN LUTHER KING ST, MOUND BAYOU, MS 38762-9314
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
37144
MS
208000000X
Pediatrics Physician
Primary
37144
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/14/2022
Last updated
05/29/2026
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