Provider Demographics
NPI:1710297189
Name:BAYNE, NATALIE LARK (LMT)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:LARK
Last Name:BAYNE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 ATHENS RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30630-2529
Mailing Address - Country:US
Mailing Address - Phone:706-743-3757
Mailing Address - Fax:877-481-8644
Practice Address - Street 1:1071 ATHENS RD
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:GA
Practice Address - Zip Code:30630-2529
Practice Address - Country:US
Practice Address - Phone:706-743-3757
Practice Address - Fax:877-481-8644
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT006932171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor