Provider Demographics
NPI:1861481335
Name:BAUER, ANNA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:BAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 HEMBREE RD
Mailing Address - Street 2:SUITE 200-A
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-475-2710
Mailing Address - Fax:770-475-0078
Practice Address - Street 1:1289 HEMBREE RD
Practice Address - Street 2:SUITE 200-A
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-475-2710
Practice Address - Fax:770-475-0078
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001950363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA612060161AMedicaid
GAR94274Medicare UPIN
GA97BBDMZMedicare ID - Type Unspecified