Healthcare Provider Details

I. General information

NPI: 1699772103
Provider Name (Legal Business Name): GARY G BAWTINHIMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 ROUNTREE RD
AYDEN NC
28513-8749
US

IV. Provider business mailing address

3675 ROUNTREE RD
AYDEN NC
28513-8749
US

V. Phone/Fax

Practice location:
  • Phone: 252-414-9072
  • Fax: 252-439-0269
Mailing address:
  • Phone: 252-414-9072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: