=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093334518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BAILEY NICOLE MANSON ATC, OTC, OT-SC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2020
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2860 RONALD REAGAN BLVD STE 300
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30041-6290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-355-0743
-----------------------------------------------------
Fax | 855-283-8851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2680 RONALD REAGAN BLVD. STE 300
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-355-0743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 246ZX2200X
-----------------------------------------------------
Taxonomy Name | Orthopedic Assistant
-----------------------------------------------------
License Number | 24-2832
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------