Healthcare Provider Details

I. General information

NPI: 1013432780
Provider Name (Legal Business Name): MONIQUE ELIZABETH BAILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/24/2023
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ALLEN COURT
NORTH AUGUSTA SC
29860
US

IV. Provider business mailing address

140 ALLEN COURT
NORTH AUGUSTA SC
29860
US

V. Phone/Fax

Practice location:
  • Phone: 803-510-0007
  • Fax: 803-510-0144
Mailing address:
  • Phone: 803-510-0007
  • Fax: 803-510-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11935
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84570
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: