Provider Demographics
NPI:1689457491
Name:BAILEY, DARRIAN MARIE
Entity Type:Individual
Prefix:
First Name:DARRIAN
Middle Name:MARIE
Last Name:BAILEY
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 1:11815 GA HIGHWAY 230
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31091-4802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 W UNION ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-1055
Practice Address - Country:US
Practice Address - Phone:229-521-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist