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General NPI Number Information
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NPI Number | 1104493808
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Entity Type | Individual
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Provider Name | SAMUEL JOHN BAPTISTE
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Gender | Male
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 220 26TH ST NW APT 6005
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City | ATLANTA
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State | GA
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Zip | 30309-1926
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Country | US
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Telephone | 912-346-2182
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Fax |
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Provider Business Mailing Address
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Address Line | 122 GORDON COMMERCIAL DR STE C
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City | LAGRANGE
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State | GA
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Zip | 30240-5754
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Country | US
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Telephone | 678-854-6093
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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