MEDICARE: JULIE J BAUTE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN144580	GA

General Provider Information

NPI Number	:	1003404880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE J BAUTE APRN

Provider Business Mailing Address
First Line	:	780 CANTON RD NE STE 205
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7242
Country	:	US
Telephone Number	:	678-224-6198
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 CANTON RD NE STE 205
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7242
Country	:	US
Telephone Number	:	678-224-6198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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