1972596898 NPI number — BAILEY SPEECH AND LANGUAGE SERVICES

Table of content: (NPI 1972596898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972596898 NPI number — BAILEY SPEECH AND LANGUAGE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAILEY SPEECH AND LANGUAGE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972596898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 S. PERRY ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-995-2378
Provider Business Mailing Address Fax Number:
678-377-9272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
735 LONGLEAF BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30045-8443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-995-2378
Provider Business Practice Location Address Fax Number:
678-377-9272
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-995-2378

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP001643 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP004673 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP000631 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP005405 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP003258 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP004594 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP000710 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000666135B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000584427B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00902745B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00970901A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000584471B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000831773A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000587386B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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