Healthcare Provider Details

I. General information

NPI: 1932237179
Provider Name (Legal Business Name): DAVID LLOYD BAILEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E WENDOVER AVE
GREENSBORO NC
27405-6713
US

IV. Provider business mailing address

1712 LAKEMONT DR
GREENSBORO NC
27410-2627
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-4717
  • Fax: 336-641-6375
Mailing address:
  • Phone: 336-854-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number100424
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number100424
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: