Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN203867 | GA |
NPI | 1013276518 |
---|---|
Provider Name | Melissa Bienacker Baughcum |
First Address | Atlanta, GA 30309-3276 |
Second Address | Athens, GA 30601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2012 |
Last Update Date | 04/09/2018 |