Provider Demographics
NPI:1497727457
Name:BAILLIE, EARLE EUGENE (MD,)
Entity Type:Individual
Prefix:DR
First Name:EARLE
Middle Name:EUGENE
Last Name:BAILLIE
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 1:404 E CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5803
Mailing Address - Country:US
Mailing Address - Phone:800-779-4858
Mailing Address - Fax:864-231-6448
Practice Address - Street 1:800 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5708
Practice Address - Country:US
Practice Address - Phone:800-779-4858
Practice Address - Fax:864-231-6448
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7122207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00180683AMedicaid
SC071228Medicaid
GA00180683AMedicaid