Provider Demographics
NPI:1407018872
Name:NICHOLS BAILEY, ALISON R (FNPC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:R
Last Name:NICHOLS 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 1:1006 HILLCREST PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4259
Mailing Address - Country:US
Mailing Address - Phone:478-272-8140
Mailing Address - Fax:
Practice Address - Street 1:1531 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3449
Practice Address - Country:US
Practice Address - Phone:478-918-0770
Practice Address - Fax:478-918-0770
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2024-05-10
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