Healthcare Provider Details

I. General information

NPI: 1528884079
Provider Name (Legal Business Name): BROOKE BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MEDICAL DR NE STE A
CARTERSVILLE GA
30121-8003
US

IV. Provider business mailing address

1930 BRANNAN RD
MCDONOUGH GA
30253-4310
US

V. Phone/Fax

Practice location:
  • Phone: 770-607-1893
  • Fax: 770-607-2930
Mailing address:
  • Phone: 678-284-4040
  • Fax: 678-284-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13988
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: