Healthcare Provider Details

I. General information

NPI: 1942208707
Provider Name (Legal Business Name): JOHN KEVIN BAUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PALMETTO HEALTH PKWY STE 400
COLUMBIA SC
29212
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3800
  • Fax: 803-744-2759
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15643
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: