Provider Demographics
NPI:1982338547
Name:BOSTIC, BAYLEY CAROLINE
Entity Type:Individual
Prefix:
First Name:BAYLEY
Middle Name:CAROLINE
Last Name:BOSTIC
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 1:5000 RESEARCH CT STE 450
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6660
Mailing Address - Country:US
Mailing Address - Phone:770-205-5551
Mailing Address - Fax:470-359-2982
Practice Address - Street 1:5000 RESEARCH CT STE 450
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6660
Practice Address - Country:US
Practice Address - Phone:770-205-5551
Practice Address - Fax:470-359-2982
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist