Healthcare Provider Details

I. General information

NPI: 1396730552
Provider Name (Legal Business Name): BILLY DEAN BAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 AUGUSTA AVE SUITE A
PADUCAH KY
42003-5515
US

IV. Provider business mailing address

854 W. JAMES CAMPBELL BLVD SUITE 303
COLUMBIA TN
38401
US

V. Phone/Fax

Practice location:
  • Phone: 270-534-0046
  • Fax: 270-534-0048
Mailing address:
  • Phone: 931-388-9706
  • Fax: 931-388-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number26804
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number16622
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: