Provider Demographics
NPI:1992116834
Name:BAILEY, COURTNEY DREW
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DREW
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 TOBIAS GADSON BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4835
Mailing Address - Country:US
Mailing Address - Phone:843-556-4380
Mailing Address - Fax:843-571-5531
Practice Address - Street 1:1470 TOBIAS GADSON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4835
Practice Address - Country:US
Practice Address - Phone:843-556-4380
Practice Address - Fax:843-571-5531
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83467207VX0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program