Provider Demographics
NPI:1790844090
Name:BAILEY, GENE ARNOLD JR (PAC)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:ARNOLD
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:PAC
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Mailing Address - Street 1:245 HOLSTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4486
Mailing Address - Country:US
Mailing Address - Phone:276-227-0460
Mailing Address - Fax:276-227-0711
Practice Address - Street 1:245 HOLSTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4486
Practice Address - Country:US
Practice Address - Phone:276-227-0460
Practice Address - Fax:276-227-0711
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2014-02-10
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Provider Licenses
StateLicense IDTaxonomies
KYPA733363A00000X
NC0010-04246363A00000X
VA0110004475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant