Healthcare Provider Details

I. General information

NPI: 1962318436
Provider Name (Legal Business Name): BAILEY BUNCH RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TECHNOLOGY CT SE STE E
SMYRNA GA
30082-5203
US

IV. Provider business mailing address

200 TECHNOLOGY CT SE STE E
SMYRNA GA
30082-5203
US

V. Phone/Fax

Practice location:
  • Phone: 770-277-6293
  • Fax: 770-288-0446
Mailing address:
  • Phone: 770-277-6293
  • Fax: 770-288-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-527224
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: