Provider Demographics
NPI:1780975623
Name:BAILEY, CARLA DENESIA (LPN)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:DENESIA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 CRAWFORD DR APT B
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-3655
Mailing Address - Country:US
Mailing Address - Phone:229-434-4569
Mailing Address - Fax:229-288-5886
Practice Address - Street 1:724 CRAWFORD DR APT B
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-3655
Practice Address - Country:US
Practice Address - Phone:229-434-4569
Practice Address - Fax:229-288-5886
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN068917164W00000X
GACN0000057044376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide