MEDICARE: MRS. LAUREN GICZEWSKI BAILEY R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD002579	GA

General Provider Information

NPI Number	:	1750684114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN GICZEWSKI BAILEY R.D.

Provider Business Mailing Address
First Line	:	620 SEA ISLAND RD
Second Line	:	273
City	:	SAINT SIMONS ISLAND
State	:	GA
Zip	:	31522-1767
Country	:	US
Telephone Number	:	912-222-7755
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 BEACHVIEW DR
Second Line	:	SUITE 2A
City	:	SAINT SIMONS ISLAND
State	:	GA
Zip	:	31522-4740
Country	:	US
Telephone Number	:	912-222-7755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	10/03/2012

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Directions to “ MRS. LAUREN GICZEWSKI BAILEY R.D.” Practice Location

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