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NPI Code Detail

MEDICARE: JOEL BAGBY

MEDICARE: JOEL BAGBY
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
1101YP2500XProfessional Counselor001431GA

General Provider Information

NPI Number : 1609406966
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL BAGBY
Provider Business Mailing Address
First Line : 304 W I PKWY STE 102
Second Line :
City : DALLAS
State : GA
Zip : 30132-5078
Country : US
Telephone Number : 770-445-8079
Fax Number :
Provider Business Practice Location Address
First Line : 304 W I PKWY STE 102
Second Line :
City : DALLAS
State : GA
Zip : 30132-5078
Country : US
Telephone Number : 770-445-8079
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2020
Last Update Date : 01/24/2020

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Directions to “ JOEL BAGBY ” Practice Location

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