Provider Demographics
NPI:1861980146
Name:BAILEY, JERRY W
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:W
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
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 131
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-0131
Mailing Address - Country:US
Mailing Address - Phone:540-235-0834
Mailing Address - Fax:
Practice Address - Street 1:1507 ROBINHOOD DR
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-2039
Practice Address - Country:US
Practice Address - Phone:540-235-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle