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General NPI Number Information
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NPI Number | 1164569158
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Entity Type | Organization
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Legal Business Name | THE BAXTER CLINIC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5914 LOVE ST
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City | AUSTELL
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State | GA
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Zip | 30168-4033
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Country | US
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Telephone | 770-739-9971
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Fax |
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Provider Business Mailing Address
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Address Line | 5914 LOVE ST
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City | AUSTELL
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State | GA
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Zip | 30168-4033
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Country | US
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Telephone | 770-739-9971
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANN INGRAM BAXTER
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Credential |
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Telephone | 770-739-9971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 027963
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License Number State | GA
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