Doctor Name: | JEREMY BAGGE |
NPI Number: | 1023085974 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 006329 |
Business Practice Address: | 11 Charlie Morris Rd Medlink Colbert Colbert, GA - 306282445 |
Business Phone Number: | 7067882127 |
Business Fax Number: | 7067882815 |
Mailing Address: | P.o. Box 495, Medlink Georgia COLBERT |
State: | GA |
Postal Code: | 306280459 |
Phone Number: | 7067883234 |
Fax Number: | 7067882936 |
NPI Enumeration Date: | 02/28/2006 |
NPI Last Update Date: | 02/01/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 006329 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |