Provider Demographics
NPI:1750684114
Name:BAILEY, LAUREN GICZEWSKI (RD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:GICZEWSKI
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SEA ISLAND RD
Mailing Address - Street 2:273
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1767
Mailing Address - Country:US
Mailing Address - Phone:912-222-7755
Mailing Address - Fax:
Practice Address - Street 1:504 BEACHVIEW DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4740
Practice Address - Country:US
Practice Address - Phone:912-222-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002579133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered