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NPI Code Detail

MEDICARE: MR. TRAVIS JERARD BAISDEN PHYSICIAN ASSISTANT

MEDICARE: MR. TRAVIS JERARD BAISDEN PHYSICIAN ASSISTANT
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
1363A00000XPhysician Assistant0110008196VA
2363A00000XPhysician Assistant12525GA

General Provider Information

NPI Number : 1316123359
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TRAVIS JERARD BAISDEN PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 3905 DUE WEST RD NW
Second Line :
City : MARIETTA
State : GA
Zip : 30064-1019
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 3905 DUE WEST RD NW
Second Line :
City : MARIETTA
State : GA
Zip : 30064-1019
Country : US
Telephone Number : 866-389-2727
Fax Number : 866-389-2727
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2008
Last Update Date : 06/23/2025

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