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General NPI Number Information
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NPI Number | 1104854231
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Entity Type | Individual
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Provider Name | JAMES ERIC BAUMGARDNER P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1670 CLAIRMONT ROAD
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City | DECATUR
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State | GA
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Zip | 30033
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Country | US
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Telephone | 404-728-4123
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Fax | 404-329-2201
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Provider Business Mailing Address
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Address Line | 1401 PARKVIEW GLEN LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3173
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Country | US
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Telephone | 770-717-1604
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA001387L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 002190
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License Number State | GA
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