Provider Demographics
NPI:1104806009
Name:BAILEY, GARRICK KEITH (MD)
Entity type:Individual
Prefix:
First Name:GARRICK
Middle Name:KEITH
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-533-4786
Practice Address - Street 1:155 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:GA
Practice Address - Zip Code:30511-4000
Practice Address - Country:US
Practice Address - Phone:706-776-2368
Practice Address - Fax:706-776-2589
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52581168OtherBCBS
GA756400OtherWELLCARE
GA302389OtherWELLCARE
GA000707176AMedicaid
GA000707176CMedicaid
GA000707176BMedicaid
GA2031816OtherAETNA HMO
GA302374OtherWELLCARE
GA302381OtherWELLCARE
GA302388OtherWELLCARE
GA5363212OtherAETNA PPO
GA5486464OtherCIGNA
GA000707176DMedicaid
GA1200031OtherUNITED HEALTHCARE
GA10032963OtherAMERIGROUP
GA1200031OtherUNITED HEALTHCARE
GA302388OtherWELLCARE