Provider Demographics
NPI:1295743003
Name:BATEMAN, SALLIE S (PA/AA)
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:S
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:PA/AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2564
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31203
Mailing Address - Country:US
Mailing Address - Phone:478-746-5644
Mailing Address - Fax:478-745-4849
Practice Address - Street 1:380 HOSPITAL DR
Practice Address - Street 2:SUITE 410
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217
Practice Address - Country:US
Practice Address - Phone:478-746-5644
Practice Address - Fax:478-745-4849
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004333367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA326281OtherWELLCARE
GAP00212669OtherRAILROAD MEDICARE
GA417581048EMedicaid
GA417581048DMedicaid
GA417581048BMedicaid
GA417581048CMedicaid
GA417581048DMedicaid
GA417581048EMedicaid
GA417581048CMedicaid