Provider Demographics
NPI:1750508602
Name:KIM T. BAIRD, FNP-CS
Entity Type:Organization
Organization Name:KIM T. BAIRD, FNP-CS
Other - Org Name:WOODBINE FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-576-5999
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-0307
Mailing Address - Country:US
Mailing Address - Phone:912-576-5999
Mailing Address - Fax:912-576-5888
Practice Address - Street 1:308 BEDELL AVE
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:GA
Practice Address - Zip Code:31569-0308
Practice Address - Country:US
Practice Address - Phone:912-576-5999
Practice Address - Fax:912-576-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR051587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00632673DMedicaid
GA50BBCSTMedicare ID - Type Unspecified
GA00632673DMedicaid