Provider Demographics
NPI:1598355869
Name:BAILEY, ORA JESSICA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ORA
Middle Name:JESSICA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-4567
Mailing Address - Country:US
Mailing Address - Phone:770-483-7211
Mailing Address - Fax:770-483-9654
Practice Address - Street 1:933 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-4567
Practice Address - Country:US
Practice Address - Phone:770-483-7211
Practice Address - Fax:770-483-9654
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist