Healthcare Provider Details

I. General information

NPI: 1700291028
Provider Name (Legal Business Name): CARYL FREDREKA BAILEY M.B.,B.S.(HONS)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST DEPARTMENT OF ANESTHESIOLOGY BI-2144
AUGUSTA GA
30912-2700
US

IV. Provider business mailing address

1120 15TH ST DEPARTMENT OF ANESTHESIOLOGY BI-2144
AUGUSTA GA
30912-2700
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3783
  • Fax: 706-721-7763
Mailing address:
  • Phone: 706-721-3783
  • Fax: 706-721-7763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number84984
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: