Provider Demographics
NPI:1518535889
Name:BAYUH, MAHTEM A
Entity Type:Individual
Prefix:
First Name:MAHTEM
Middle Name:A
Last Name:BAYUH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BALL ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3308
Mailing Address - Country:US
Mailing Address - Phone:478-987-1222
Mailing Address - Fax:478-987-1512
Practice Address - Street 1:1100 BALL ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3308
Practice Address - Country:US
Practice Address - Phone:478-987-1222
Practice Address - Fax:478-987-1512
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist