Provider Demographics
NPI:1659358448
Name:JONES-BAILEY, ALISE MARIE (MD)
Entity Type:Individual
Prefix:MS
First Name:ALISE
Middle Name:MARIE
Last Name:JONES-BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 285
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4943
Mailing Address - Country:US
Mailing Address - Phone:770-667-9997
Mailing Address - Fax:770-667-8447
Practice Address - Street 1:11660 ALPHARETTA HWY
Practice Address - Street 2:SUITE 285
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4943
Practice Address - Country:US
Practice Address - Phone:770-667-9997
Practice Address - Fax:770-667-8447
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00469268DMedicaid
GAE03218Medicare UPIN
GA00469268DMedicaid