Healthcare Provider Details

I. General information

NPI: 1780975623
Provider Name (Legal Business Name): CARLA DENESIA BAILEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 CRAWFORD DR APT B
ALBANY GA
31705-3655
US

IV. Provider business mailing address

724 CRAWFORD DR APT B
ALBANY GA
31705-3655
US

V. Phone/Fax

Practice location:
  • Phone: 229-434-4569
  • Fax: 229-288-5886
Mailing address:
  • Phone: 229-434-4569
  • Fax: 229-288-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0000057044
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN068917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: