MEDICARE: DR. HENRY JOE BAUGHMAN M.D.

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	208000000X	Pediatrics Physician	045395	GA
2	208000000X	Pediatrics Physician	30562	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174514186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY JOE BAUGHMAN M.D.

Provider Business Mailing Address
First Line	:	375 BOYNTON DR
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-2775
Country	:	US
Telephone Number	:	706-937-3331
Fax Number	:	706-937-3346

Provider Business Practice Location Address
First Line	:	375 BOYNTON DR.
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-2775
Country	:	US
Telephone Number	:	706-937-3331
Fax Number	:	706-937-3346

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	06/22/2010

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