Healthcare Provider Details

I. General information

NPI: 1407018872
Provider Name (Legal Business Name): RENEE NICHOLS BAILEY FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON RENEE RHODES NP

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N CAMELLIA BLVD
FORT VALLEY GA
31030-3368
US

IV. Provider business mailing address

209 N CAMELLIA BLVD
FORT VALLEY GA
31030-3368
US

V. Phone/Fax

Practice location:
  • Phone: 478-822-0054
  • Fax: 478-822-0059
Mailing address:
  • Phone: 478-822-0054
  • Fax: 478-822-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP107764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: