Healthcare Provider Details

I. General information

NPI: 1750508602
Provider Name (Legal Business Name): KIM T. BAIRD, FNP-CS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BEDELL AVE
WOODBINE GA
31569-0308
US

IV. Provider business mailing address

PO BOX 307
WOODBINE GA
31569-0307
US

V. Phone/Fax

Practice location:
  • Phone: 912-576-5999
  • Fax: 912-576-5888
Mailing address:
  • Phone: 912-576-5999
  • Fax: 912-576-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR051587
License Number StateGA

VIII. Authorized Official

Name: DELORES HAMILTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-576-5999