Provider Demographics
NPI:1043747215
Name:BAILEY, BRUCE ANTHONY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ANTHONY
Last Name:BAILEY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W ROBERT TOOMBS AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-1662
Mailing Address - Country:US
Mailing Address - Phone:706-318-3158
Mailing Address - Fax:
Practice Address - Street 1:107 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-1623
Practice Address - Country:US
Practice Address - Phone:706-318-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3036146L00000X
GA219236163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163WE0003XNursing Service ProvidersRegistered NurseEmergency