Provider Demographics
NPI:1720597669
Name:BAUMGARTNER, KARLA C (PTA)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:C
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WOOD LAKE DR APT 535
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6962
Mailing Address - Country:US
Mailing Address - Phone:706-224-2283
Mailing Address - Fax:
Practice Address - Street 1:1680 HIGHWAY 138 SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1281
Practice Address - Country:US
Practice Address - Phone:770-760-0066
Practice Address - Fax:770-922-7599
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003855225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA840M83182OtherBLUE CROSS BLUE SHIELD