Healthcare Provider Details

I. General information

NPI: 1962877001
Provider Name (Legal Business Name): COURTNEY BALDWIN CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY BALDWIN CSA

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 SPURGEON ST
WAYCROSS GA
31501
US

IV. Provider business mailing address

901 EMERALD CT
WOODSTOCK GA
30189-5183
US

V. Phone/Fax

Practice location:
  • Phone: 912-281-9105
  • Fax:
Mailing address:
  • Phone: 912-281-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number4601
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number144370
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: