Provider Demographics
NPI:1710074273
Name:BAILEY, AMANDA HEATHER (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:HEATHER
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:357 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5935
Mailing Address - Country:US
Mailing Address - Phone:704-664-7328
Mailing Address - Fax:704-664-7783
Practice Address - Street 1:357 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5935
Practice Address - Country:US
Practice Address - Phone:704-664-7328
Practice Address - Fax:704-664-7783
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014425207Q00000X
PAOT011566207Q00000X
WV2688207Q00000X
NC201502211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARES000Medicare UPIN