Healthcare Provider Details

I. General information

NPI: 1114910338
Provider Name (Legal Business Name): CAROLYN MAY BAILEY DO FACOFP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 S ALEX RD
WEST CARROLLTON OH
45449-5404
US

IV. Provider business mailing address

1 PRESTIGE PL SUITE 550
MIAMISBURG OH
45342-3794
US

V. Phone/Fax

Practice location:
  • Phone: 937-865-0534
  • Fax: 937-865-0721
Mailing address:
  • Phone: 937-752-2305
  • Fax: 937-522-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34001443
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34001443
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: