Individual
STEPHANIE JANE BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5700
Mailing address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5700
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW003963
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I808572
MEDICARE PTAN
GA
Enumeration date
06/23/2009
Last updated
04/29/2010
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