MEDICARE: BAILEIGH GOOLSBY

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1124665880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEIGH GOOLSBY

Provider Business Mailing Address
First Line	:	152 RIDGE AVE S
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-4735
Country	:	US
Telephone Number	:	845-458-8755
Fax Number	:	845-510-8333

Provider Business Practice Location Address
First Line	:	109 DAVIS RD
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-2383
Country	:	US
Telephone Number	:	706-487-3500
Fax Number	:

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

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/30/2025

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Directions to “ BAILEIGH GOOLSBY ” Practice Location

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