MEDICARE: BAILEY KENDRICK PARIS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	MSW011445	GA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1053938266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY KENDRICK PARIS LMSW

Provider Business Mailing Address
First Line	:	1311 ROCKING CHAIR CT
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-2456
Country	:	US
Telephone Number	:	229-848-7738
Fax Number	:

Provider Business Practice Location Address
First Line	:	4343 SHALLOWFORD RD STE 410
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5067
Country	:	US
Telephone Number	:	678-384-4911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2020
Last Update Date	:	08/22/2023

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