Provider Demographics
NPI:1548276520
Name:BAILEY, JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BAILEY
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 1:123 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-3416
Mailing Address - Country:US
Mailing Address - Phone:662-256-7112
Mailing Address - Fax:662-256-7116
Practice Address - Street 1:1127 EARL FRYE BLVD # A
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5516
Practice Address - Country:US
Practice Address - Phone:662-257-2324
Practice Address - Fax:662-257-2325
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06379207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS115038Medicaid
MS115038Medicaid