Provider Demographics
NPI:1649878208
Name:BAILEY, JILL K
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:K
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 BARKER RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-1902
Mailing Address - Country:US
Mailing Address - Phone:423-834-8735
Mailing Address - Fax:877-797-0629
Practice Address - Street 1:1003 ALABASTER CV
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3607
Practice Address - Country:US
Practice Address - Phone:423-834-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor