Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0124 | GA |
N | 222Z00000X | Podiatrist | 0124 | GA |
Y | 224P00000X | Prosthetist | 0124 | GA |
NPI | 1033885975 |
---|---|
Provider Name | Mr. David Baggett |
First Address | Rome, GA 30165-1537 |
Second Address | Rome, GA 30165-1537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2021 |
Last Update Date | 20/08/2021 |