MEDICARE: HOLMES BAKER MARCHMAN MD

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	208100000X	Physical Medicine & Rehabilitation Physician	037021	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	250006460	OTHER	GA	RR MEDICARE-GRP # CC4177

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10045238	OTHER	GA	AMERIGROUP
3	340872	OTHER	GA	WELLCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4502072	OTHER	GA	AETNA
6	52451378	OTHER	GA	BCBS
7	2300300	OTHER	GA	UNITED HEALTHCARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	4783129	OTHER	GA	CIGNA

General Provider Information

NPI Number	:	1720068190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLMES BAKER MARCHMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 658
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30503-0658
Country	:	US
Telephone Number	:	770-718-1122
Fax Number	:	770-535-7445

Provider Business Practice Location Address
First Line	:	655 JESSE JEWELL PKWY SE
Second Line	:	SUITE B
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3756
Country	:	US
Telephone Number	:	770-536-6300
Fax Number	:	770-536-6006

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	03/06/2019

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Directions to “ HOLMES BAKER MARCHMAN MD” Practice Location

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