Provider Demographics
NPI:1033764436
Name:BAILEY, JAMES THOMAS III (DPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:BAILEY
Suffix:III
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 N EAST END RD
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37871-1439
Mailing Address - Country:US
Mailing Address - Phone:865-207-6913
Mailing Address - Fax:
Practice Address - Street 1:7565 DANNAHER DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4029
Practice Address - Country:US
Practice Address - Phone:865-859-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist