Provider Demographics
NPI:1124873138
Name:BAILEY, JENNIFER OLIVIA
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:OLIVIA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 FOXY DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-7666
Mailing Address - Country:US
Mailing Address - Phone:678-227-3384
Mailing Address - Fax:
Practice Address - Street 1:2331 FOXY DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-7666
Practice Address - Country:US
Practice Address - Phone:678-227-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014221468376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide