Provider Demographics
NPI:1043757842
Name:FAWCETT, CAROLINE BAILEY
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:BAILEY
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 CHRISPEN TRCE SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1470
Mailing Address - Country:US
Mailing Address - Phone:404-825-7637
Mailing Address - Fax:
Practice Address - Street 1:430 CHRISPEN TRCE SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1470
Practice Address - Country:US
Practice Address - Phone:404-825-7637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer