Provider Demographics
NPI:1740400662
Name:BAILEY, JESSICA GURLEY (MED)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:GURLEY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 QUEEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-4792
Mailing Address - Country:US
Mailing Address - Phone:706-436-2677
Mailing Address - Fax:
Practice Address - Street 1:124 ANKERICH RD
Practice Address - Street 2:
Practice Address - City:BOWERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30516-2308
Practice Address - Country:US
Practice Address - Phone:706-856-7369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist