MEDICARE: MRS. MARISA BAILEY RN

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	367500000X	Certified Registered Nurse Anesthetist	RN264966	GA
2	163WC0200X	Critical Care Medicine Registered Nurse	RN264966	GA

General Provider Information

NPI Number	:	1063089464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARISA BAILEY RN

Provider Business Mailing Address
First Line	:	245 MEELER CIR
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-6844
Country	:	US
Telephone Number	:	404-394-6132
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 MEELER CIR
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-6844
Country	:	US
Telephone Number	:	404-394-6132
Fax Number	:

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

Provider Enumeration Date	:	06/05/2021
Last Update Date	:	10/19/2025

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