=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932948932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. BAILEY JOHNSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2024
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2470 MOUNT ZION PKWY
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30236-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-365-0966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3322 ALTALOMA DR
-----------------------------------------------------
City | VESTAVIA HILLS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35216-4217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-612-9041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AUD004404
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------