Healthcare Provider Details

I. General information

NPI: 1942904420
Provider Name (Legal Business Name): EMMA BAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OGLETHORPE AVE STE C7
ATHENS GA
30606-2221
US

IV. Provider business mailing address

7428 SESAME ST
COLUMBUS GA
31909-2639
US

V. Phone/Fax

Practice location:
  • Phone: 706-425-9445
  • Fax: 706-425-0820
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number296086
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: