Provider Demographics
NPI:1629436050
Name:BAILEY, JESSICA F (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:F
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:SUITE 450
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6859
Practice Address - Country:US
Practice Address - Phone:803-434-8800
Practice Address - Fax:803-434-8802
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2018-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC2500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2740PAMedicaid
SCSC89095774Medicare PIN