Healthcare Provider Details

I. General information

NPI: 1285398305
Provider Name (Legal Business Name): BAILEY LENZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 01/06/2022
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

33 AUTUMN TRAIL WAY
WAVERLY HALL GA
31831-2455
US

V. Phone/Fax

Practice location:
  • Phone: 706-321-3738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberGA-RN258129
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN258129
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: