Provider Demographics
NPI:1760910970
Name:BAILEY, ZACH BREWER
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:BREWER
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N INGRAM ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-3510
Mailing Address - Country:US
Mailing Address - Phone:931-309-8234
Mailing Address - Fax:
Practice Address - Street 1:433 W MADISON ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-2716
Practice Address - Country:US
Practice Address - Phone:931-363-9874
Practice Address - Fax:931-363-9873
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN948338309OtherUNITED HEALTHCARE