Healthcare Provider Details

I. General information

NPI: 1285026757
Provider Name (Legal Business Name): CHRIS BAUMANN RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 HIGHWAY 334
COMMERCE GA
30530-5987
US

IV. Provider business mailing address

6420 FALLING WATER LN
HOSCHTON GA
30548-8204
US

V. Phone/Fax

Practice location:
  • Phone: 706-336-3921
  • Fax:
Mailing address:
  • Phone: 706-362-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD003439
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: