Healthcare Provider Details

I. General information

NPI: 1053595348
Provider Name (Legal Business Name): JAIME RENA BAILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

1949 GUNBARREL RD STE 206
CHATTANOOGA TN
37421-3188
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-7404
  • Fax: 423-495-2625
Mailing address:
  • Phone: 423-495-4349
  • Fax: 423-495-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41467
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48393
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48393
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: