Provider Demographics
NPI:1932155397
Name:LAUREL BAYE MEDICAL, LLC
Entity type:Organization
Organization Name:LAUREL BAYE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:404-244-8211
Mailing Address - Street 1:6350 REGENCY PARKWAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2338
Mailing Address - Country:US
Mailing Address - Phone:404-244-8211
Mailing Address - Fax:404-244-8767
Practice Address - Street 1:6350 REGENCY PARKWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2338
Practice Address - Country:US
Practice Address - Phone:404-244-8211
Practice Address - Fax:404-244-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X, 335E00000X
GA1932155397332BP3500X
332B00000X, 332BX2000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA82-00259OtherEVERCARE PROVIDER NUMBER
GA000933215AMedicaid
GA933215AMedicaid
SCDE1956Medicaid
SCDE1956Medicaid