Provider Demographics
NPI:1932631223
Name:BAILEY, IAIN MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:IAIN
Middle Name:MATTHEW
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 CLIFTON RD
Mailing Address - Street 2:DEPARTMENT OF REHABILITATION MEDICINE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-712-5511
Mailing Address - Fax:
Practice Address - Street 1:101 MED TECH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4001
Practice Address - Country:US
Practice Address - Phone:423-232-6120
Practice Address - Fax:423-232-6125
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227168207R00000X
TN655522081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNFB1601360OtherDEA CERTIFICATION