Healthcare Provider Details

I. General information

NPI: 1376908939
Provider Name (Legal Business Name): SAVANNAH BAILEY ATC, V-LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24164 BELLEAU AVE
QUANTICO VA
22134-5106
US

IV. Provider business mailing address

17019 CASS BROOK LN
WOODBRIDGE VA
22191-5162
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-6558
  • Fax:
Mailing address:
  • Phone: 864-346-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0126001416
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: