Individual
AYN VINCENT DEJESUS BAYANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 FAIRVIEW PARK DR, SUITE B, DUBLIN, GA 31021-2547
(478) 275-0792
(478) 275-0713
Mailing address
PO BOX 16190, DUBLIN, GA 31040-6190
(478) 275-0792
(478) 275-0713
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
055470
GA
207RP1001X
Pulmonary Disease Physician
Primary
055470
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0868802730
CHAMPUS
GA
01
—
161839
BCBS
GA
05
—
555475686A
—
GA
05
—
555475686B
—
GA
01
—
P00200156
RR MEDICARE
GA
Enumeration date
04/19/2006
Last updated
01/06/2011
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