Search › Georgia › 367500000X
Keandrea Bacon
NPI 1619712676 · on the registry since 2024 · sole proprietor
Practice
- Address
- 120 Whirlaway Dr
Ellenwood, GA 30294 - Phone
- (404) 444-3887
Registry record
- Primary taxonomy
- 367500000X
367500000X
- Also registered as
- 163W00000X
- Licence states on file
- GA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2025-09-23
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia