Provider Demographics
NPI:1306894951
Name:BAILEY, MARION THOMAS JR (MD)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:THOMAS
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:THOMAS
Other - Last Name:BAILEY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:130 N GROSS RD
Mailing Address - Street 2:STE 201
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6277
Mailing Address - Country:US
Mailing Address - Phone:912-729-2795
Mailing Address - Fax:912-729-4117
Practice Address - Street 1:70 LINDSEY LN
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6835
Practice Address - Country:US
Practice Address - Phone:912-882-8018
Practice Address - Fax:912-510-6035
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA361790638AMedicaid
GA11SCGDPMedicare ID - Type UnspecifiedMEDICARE