Healthcare Provider Details

I. General information

NPI: 1285158857
Provider Name (Legal Business Name): BAKER SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 OAKTOWN PL
LAWRENCEVILLE GA
30044-3864
US

IV. Provider business mailing address

6127 GOODWIN DR
COLUMBUS GA
31909
US

V. Phone/Fax

Practice location:
  • Phone: 770-985-4257
  • Fax: 770-985-4258
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number95152
License Number StateGA

VIII. Authorized Official

Name: PAM PHILLIP
Title or Position: PATIENT ACC MGR
Credential:
Phone: 770-985-4257