Provider Demographics
NPI:1467631895
Name:BAILEY, TONY DALE (RN)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:DALE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30112-0025
Mailing Address - Country:US
Mailing Address - Phone:770-258-1227
Mailing Address - Fax:770-258-1227
Practice Address - Street 1:2789 CARROLLTON VILLA RICA HWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-5597
Practice Address - Country:US
Practice Address - Phone:770-258-1227
Practice Address - Fax:770-258-1227
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse