Healthcare Provider Details

I. General information

NPI: 1780598573
Provider Name (Legal Business Name): ANITA BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 GREYHAWK LN
CUMMING GA
30040-1221
US

IV. Provider business mailing address

2910 GREYHAWK LN
CUMMING GA
30040-1221
US

V. Phone/Fax

Practice location:
  • Phone: 678-755-3504
  • Fax:
Mailing address:
  • Phone: 678-755-3504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberPHCP045273
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: