Provider Demographics
NPI:1508004862
Name:BAILEY, MARTIN HAMILTON (DPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:HAMILTON
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-4739
Mailing Address - Country:US
Mailing Address - Phone:423-623-6492
Mailing Address - Fax:423-623-6866
Practice Address - Street 1:771 COSBY HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3426
Practice Address - Country:US
Practice Address - Phone:423-623-1500
Practice Address - Fax:423-625-1196
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist