Healthcare Provider Details

I. General information

NPI: 1114103785
Provider Name (Legal Business Name): DARRON P BAHAM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 HIGHWAY 34 E SUITE 2200
NEWNAN GA
30265-5631
US

IV. Provider business mailing address

1755 HIGHWAY 34 E SUITE 2200
NEWNAN GA
30265-5631
US

V. Phone/Fax

Practice location:
  • Phone: 770-502-2175
  • Fax: 770-502-2169
Mailing address:
  • Phone: 770-502-2175
  • Fax: 770-502-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: