Bethany R Hairston MD
Organization Active NPI Dermatology Physician · Columbus, MS
NPI 1982836037 · NPPES record last updated Apr 14, 2026
Key facts
- NPI
- 1982836037
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- BETHANY R HAIRSTON MD
- Practice address
- 724 Leigh Drive
Columbus, MS 39705-3098 - Phone
- (662) 328-3375
- Fax
- (662) 328-3395
- NPI assigned
- Aug 21, 2009
- Organization subpart
- No
Authorized official
- Name
- Bethany R Hairston, MD
- Title
- Owner/Practitioner
- Phone
- (662) 328-3375
Practitioners 6
-
Bethany Hairston, M.D.
-
Mason Olivia Siddiqui, PA-C
-
Kala White Wilson, CFNP
-
Anna E Woodson, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D1104969 | Bethany R Hairston MD PLLC Dba Vitality Dermatolog | Compliance | Jan 25, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100528000221 | MS | Part B Supplier - Clinic/Group Practice | 0143359257 |
Receives reassigned benefits from 5 practitioners Practice locations: Columbus, MS |
National Provider Directory
Locations
724 Leigh Dr
Columbus, MS 39705
Phone (662) 328-3375
255 Baptist Blvd
Ste 304
Columbus, MS 39705
Phone (662) 244-2966
321 University Dr
Starkville, MS 39759
Phone (662) 323-5377
Interoperability endpoints
- bhairston@directaddress.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
724 Leigh Drive
Columbus, MS 39705-3098
Mailing address
724 Leigh Dr
Columbus, MS 39705-3098
Phone (662) 328-3375
Other practice location 1
321 University Dr
Starkville, MS 39759-2956
Phone (662) 328-3375
Other names
- The Dermatology Clinic
- Vitality Dermatology
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | bhairston@directaddress.net | Health Information Exchange (HIE) |
Other providers in Columbus, MS
- Antavious Kemar Belgrave
- Benevolent Living Services
- James Daniel Bennett III
- Kala Benton
- Michael Allen Berry
- Birva Bhatt
- Cequeila Vontae Bigbee
- Christy C Black
- Gloria Blackmon
- Mary Elizabeth Blake
All providers in Columbus, MS · Dermatology Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.