Basic Information
| Provider Information | |||||||||
| NPI: | 1487697504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | QUIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 MEMORIAL MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642954210 | ||||||||
| FaxNumber: | 8642951473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 22356 | SC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7371834 | 01 | SC | CIGNA | OTHER | 571004971004 | 01 | SC | BCBS OF SC | OTHER | P00713066 | 01 | SC | RR MEDICARE | OTHER | T65373 | 05 | SC | MEDICAID | 7610242 | 01 | SC | AETNA | OTHER |