Provider Demographics
NPI:1174514186
Name:BAUGHMAN, HENRY JOE (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOE
Last Name:BAUGHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:375 BOYNTON DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2775
Mailing Address - Country:US
Mailing Address - Phone:706-937-3331
Mailing Address - Fax:706-937-3346
Practice Address - Street 1:375 BOYNTON DR.
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2775
Practice Address - Country:US
Practice Address - Phone:706-937-3331
Practice Address - Fax:706-937-3346
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045395208000000X
TN30562208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00794175DMedicaid
GAG59301Medicare UPIN