Healthcare Provider Details

I. General information

NPI: 1649443888
Provider Name (Legal Business Name): MELISSA MARIE BAKLARZ R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD
AUGUSTA GA
30905-5741
US

IV. Provider business mailing address

2303 SPRING HOUSE LN APT G
AUGUSTA GA
30907-3497
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-2880
  • Fax:
Mailing address:
  • Phone: 240-997-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR178199
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: