Provider Demographics
NPI:1114103785
Name:BAHAM, DARRON P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DARRON
Middle Name:P
Last Name:BAHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 HIGHWAY 34 E
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5631
Mailing Address - Country:US
Mailing Address - Phone:770-502-2175
Mailing Address - Fax:770-502-2169
Practice Address - Street 1:1755 HIGHWAY 34 E
Practice Address - Street 2:SUITE 2200
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5631
Practice Address - Country:US
Practice Address - Phone:770-502-2175
Practice Address - Fax:770-502-2169
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4424363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical