Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 200501042 | NC |
NPI | 1073538328 |
---|---|
Provider Name | Dwight Bailey |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28203-5866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 05/01/2022 |