Healthcare Provider Details

I. General information

NPI: 1174439368
Provider Name (Legal Business Name): MADISON ELIZABETH BAILEY M.ED., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 RACETRACK RD
MCDONOUGH GA
30252-1022
US

IV. Provider business mailing address

382 RACETRACK RD
MCDONOUGH GA
30252-1022
US

V. Phone/Fax

Practice location:
  • Phone: 678-205-5437
  • Fax:
Mailing address:
  • Phone: 678-205-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP014299
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: