Provider Demographics
NPI:1417935339
Name:BAILES, GEORGE STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:STEVEN
Last Name:BAILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:BAILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:105 POWELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1531
Mailing Address - Country:US
Mailing Address - Phone:864-574-0070
Mailing Address - Fax:864-574-0882
Practice Address - Street 1:105 POWELL MILL RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1531
Practice Address - Country:US
Practice Address - Phone:864-574-0070
Practice Address - Fax:864-574-0882
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080038473OtherRR MCR
SC108715Medicaid
D99188Medicare UPIN
080038473OtherRR MCR