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General NPI Number Information
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NPI Number | 1043046519
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Entity Type | Individual
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Provider Name | GINA LEEANN BAUKNECHT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 3905 BROOKSIDE PKWY STE 300
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City | ALPHARETTA
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State | GA
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Zip | 30022-4458
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Country | US
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Telephone | 770-442-1911
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Fax |
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Provider Business Mailing Address
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Address Line | 280 OLD HICKORY RD
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City | WOODSTOCK
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State | GA
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Zip | 30188-4555
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Country | US
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Telephone | 931-472-9556
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN331352
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License Number State | GA
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