Provider Demographics
NPI:1699775882
Name:BAILEY-NUTTING, MAUREEN (PA)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:BAILEY-NUTTING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-271-1464
Mailing Address - Fax:864-467-9119
Practice Address - Street 1:1028 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1639
Practice Address - Country:US
Practice Address - Phone:864-271-1464
Practice Address - Fax:864-467-9119
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1097363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1049253OtherNCCPA
1699775882OtherNPI NUMBER
SC1097OtherSTATE MEDICAL LICENSE NUMBER
SC1049253OtherNCCPA
SC1097OtherSTATE MEDICAL LICENSE NUMBER