Provider Demographics
NPI:1063003275
Name:QAWIY, BAYINAH HABIBA
Entity Type:Individual
Prefix:
First Name:BAYINAH
Middle Name:HABIBA
Last Name:QAWIY
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 1:6571 BENT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2104
Mailing Address - Country:US
Mailing Address - Phone:678-222-8789
Mailing Address - Fax:
Practice Address - Street 1:6571 BENT CREEK DR
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-2104
Practice Address - Country:US
Practice Address - Phone:678-222-8789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician