Provider Demographics
NPI:1902549769
Name:BAILEY, JILL KATHLEEN (DO)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:KATHLEEN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:BAILEY
Other - Last Name:KANDELAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-264-6000
Mailing Address - Fax:
Practice Address - Street 1:4 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7230
Practice Address - Country:US
Practice Address - Phone:601-579-5444
Practice Address - Fax:601-579-3083
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS35149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine