Basic Information
| Provider Information | |||||||||
| NPI: | 1407873011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | STANTON | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 405473 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303845473 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 970 MEDICAL DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | BRIGHAM CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843023286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356952273 | ||||||||
| FaxNumber: | 4356952278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 274750-1205 | UT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 870419324004 | 05 | UT | MEDICAID | 528080509002 | 05 | UT | MEDICAID |