Provider Demographics
NPI:1740625110
Name:BAILEY, PRESTON F III (ED S)
Entity type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:F
Last Name:BAILEY
Suffix:III
Gender:M
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 OLD FURNACE RD
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-9639
Mailing Address - Country:US
Mailing Address - Phone:864-578-0128
Mailing Address - Fax:864-515-5158
Practice Address - Street 1:3231 OLD FURNACE RD
Practice Address - Street 2:
Practice Address - City:CHESNEE
Practice Address - State:SC
Practice Address - Zip Code:29323-9639
Practice Address - Country:US
Practice Address - Phone:864-578-0128
Practice Address - Fax:864-515-5158
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1285684910Medicaid