Healthcare Provider Details

I. General information

NPI: 1336794734
Provider Name (Legal Business Name): JEFFERY ALLAN BAGGETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2019
Last Update Date: 08/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1785
US

IV. Provider business mailing address

2310 N PATTERSON ST BLDG C
VALDOSTA GA
31602-2500
US

V. Phone/Fax

Practice location:
  • Phone: 229-433-1000
  • Fax:
Mailing address:
  • Phone: 229-244-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN223722
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: