Provider Demographics
NPI:1902624794
Name:BAILEY, ROGER ARISTOTLE
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:ARISTOTLE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 AQUINNAH DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-8277
Mailing Address - Country:US
Mailing Address - Phone:214-994-3704
Mailing Address - Fax:
Practice Address - Street 1:121 AQUINNAH DR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-8277
Practice Address - Country:US
Practice Address - Phone:214-994-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care