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General NPI Number Information
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NPI Number | 1912956939
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Entity Type | Individual
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Provider Name | DOUGLAS O. BAXLEY CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 247 S MAIN ST
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City | REIDSVILLE
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State | GA
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Zip | 30453-4605
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Country | US
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Telephone | 912-557-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 285 RHETT CIR
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City | JACKSON
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State | AL
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Zip | 36545-8703
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Country | US
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Telephone | 251-246-9594
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1-056701
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License Number State | AL
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