Provider Demographics
NPI:1083706113
Name:BAILEY, JOSEPH C (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
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 1:2050 MEADOWVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-230-5000
Mailing Address - Fax:423-230-5097
Practice Address - Street 1:2428 KNOB CREEK ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-282-5054
Practice Address - Fax:423-230-5097
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38534207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3894082Medicaid
NC5900865Medicaid
VA139835OtherANTHEM
TN4087319OtherBCBS
TN0108OtherJDH
VA010087210Medicaid
TN4087319OtherBCBS
TN3894082Medicare ID - Type Unspecified
VA139835OtherANTHEM
TN3373123Medicare ID - Type UnspecifiedGROUP
C73018Medicare UPIN
NC5900865Medicaid