Healthcare Provider Details

I. General information

NPI: 1265250112
Provider Name (Legal Business Name): ABBIE BASKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 N ASHLEY ST STE 120
VALDOSTA GA
31602-5944
US

IV. Provider business mailing address

3121 N OAK STREET EXT
VALDOSTA GA
31602-1099
US

V. Phone/Fax

Practice location:
  • Phone: 800-832-9419
  • Fax:
Mailing address:
  • Phone: 800-832-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: