Provider Demographics
NPI:1578785523
Name:BAUTISTA, GRACE C (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:103 WEST GENERAL SCREVEN WAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-877-7338
Mailing Address - Fax:912-876-3558
Practice Address - Street 1:103 WEST GENERAL SCREVEN WAY
Practice Address - Street 2:SUITE E
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-877-7338
Practice Address - Fax:912-876-3558
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA16775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine