Active NPI
Bailey Bagwell, BCBA
- Behavior Analyst
- Marietta, GA
National Provider Identifier
1205516101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 23-2157-435199
- Practice address
- 24 Whitlock SQ SW
Marietta, GA 30064-3260 - Phone
- (678) 301-0071
- NPI assigned
- Jul 25, 2023
- Last updated
- Jul 25, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 23-2157-435199 | GA | Primary |
Addresses
Primary practice location
24 Whitlock SQ SW
Marietta, GA 30064-3260
Mailing address
24 Whitlock SQ SW
Marietta, GA 30064-3260
Phone (678) 301-0071
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-2157-435199 | GA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690243200000",
"number": "1205516101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 WHITLOCK SQ SW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300643260",
"telephone_number": "678-301-0071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 WHITLOCK SQ SW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300643260",
"telephone_number": "678-301-0071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGWELL",
"first_name": "BAILEY",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-25",
"last_updated": "2023-07-25",
"certification_date": "2023-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "GA",
"license": "23-2157-435199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.