Provider Demographics
NPI:1609801810
Name:BAILEY, BRIAN MARCUS (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MARCUS
Last Name:BAILEY
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 1:602 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4913
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-7850
Practice Address - Street 1:5354 REYNOLDS ST STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6008
Practice Address - Country:US
Practice Address - Phone:912-819-0500
Practice Address - Fax:912-819-0501
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057930208G00000X, 208G00000X
MO2011003860208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA057930OtherGEORGIA MEDICAL LICENSE
MO1609801810Medicaid
SC289814Medicaid
SC289814Medicaid
MOPENDINGMedicare PIN
GAP01593952OtherRAILROAD MEDICARE
MO1609801810Medicaid
MO1609801810Medicaid
GA33BDBHWMedicare PIN