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NPI Code Detail

MEDICARE: SAMUEL JOHN BAPTISTE

MEDICARE: SAMUEL JOHN BAPTISTE
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1104493808
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL JOHN BAPTISTE
Provider Business Mailing Address
First Line : 122 GORDON COMMERCIAL DR STE C
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-5754
Country : US
Telephone Number : 678-854-6093
Fax Number :
Provider Business Practice Location Address
First Line : 220 26TH ST NW APT 6005
Second Line :
City : ATLANTA
State : GA
Zip : 30309-1926
Country : US
Telephone Number : 912-346-2182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2021
Last Update Date : 06/10/2021

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