Healthcare Provider Details

I. General information

NPI: 1336113299
Provider Name (Legal Business Name): RENALI AMPARO C. AGBAYANI-BAUTISTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 DAN PROCTOR DR. SUITE 140
ST. MARYS GA
31558
US

IV. Provider business mailing address

2040 DAN PROCTOR DR. SUITE 140
ST. MARYS GA
31558
US

V. Phone/Fax

Practice location:
  • Phone: 912-673-8000
  • Fax: 912-673-8003
Mailing address:
  • Phone: 912-673-8000
  • Fax: 912-673-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number056675
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: