Provider Demographics
NPI:1124558135
Name:BAYLESS, JAKE HAMILTON (DO)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:HAMILTON
Last Name:BAYLESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-488-4900
Mailing Address - Fax:980-488-4905
Practice Address - Street 1:10905 PROVIDENCE RD W
Practice Address - Street 2:STE G200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1538
Practice Address - Country:US
Practice Address - Phone:980-488-4900
Practice Address - Fax:980-488-4905
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL40693207Q00000X
NC2023-03317208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine