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General NPI Number Information
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NPI Number | 1649878208
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Entity Type | Individual
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Provider Name | JILL K BAILEY
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 05/13/2023
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Provider Practice Location Address
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Address Line | 1003 ALABASTER CV
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City | SANFORD
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State | FL
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Zip | 32771-3607
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Country | US
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Telephone | 423-834-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 610 BARKER RD
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City | HIXSON
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State | TN
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Zip | 37343-1902
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Country | US
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Telephone | 423-834-8735
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Fax | 877-797-0629
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State | FL
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