Provider Demographics
NPI:1407018872
Name:BAILEY, RENEE NICHOLS (FNPC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:NICHOLS
Last Name:BAILEY
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:RENEE
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:209 N CAMELLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-3368
Mailing Address - Country:US
Mailing Address - Phone:478-822-0054
Mailing Address - Fax:478-822-0059
Practice Address - Street 1:209 N CAMELLIA BLVD
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-3368
Practice Address - Country:US
Practice Address - Phone:478-822-0054
Practice Address - Fax:478-822-0059
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107764363LF0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147242AMedicaid
SCD90835Medicare UPIN
423836Medicare Oscar/Certification
SCD90835Medicare UPIN
SCRHC004Medicaid
423836Medicare Oscar/Certification