Provider Demographics
NPI:1104854231
Name:BAUMGARDNER, JAMES ERIC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ERIC
Last Name:BAUMGARDNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1401 PARKVIEW GLEN LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3173
Mailing Address - Country:US
Mailing Address - Phone:770-717-1604
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT ROAD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-728-4123
Practice Address - Fax:404-329-2201
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001387L363A00000X
GA002190363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical