Provider Demographics
NPI:1982727400
Name:SCOGGINS, JENNIE BAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:BAKER
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIE
Other - Middle Name:MAE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:550 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1411
Mailing Address - Country:US
Mailing Address - Phone:478-741-3007
Mailing Address - Fax:
Practice Address - Street 1:411 TOWN PARK BLVD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3487
Practice Address - Country:US
Practice Address - Phone:706-854-2500
Practice Address - Fax:706-854-2559
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125065OMedicaid
GA003125065MMedicaid