Healthcare Provider Details

I. General information

NPI: 1376466201
Provider Name (Legal Business Name): GRISELDA BAILON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 GRASSLAND PKWY STE B
ALPHARETTA GA
30004-8601
US

IV. Provider business mailing address

1506 CHELSEA DOWNS DR NE
CONYERS GA
30013-5713
US

V. Phone/Fax

Practice location:
  • Phone: 678-580-1404
  • Fax:
Mailing address:
  • Phone: 678-973-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: