Provider Demographics
NPI:1730620410
Name:BAUGHAM, JOE (PA-C)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:BAUGHAM
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3334 CAPITAL MEDICAL BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4470
Mailing Address - Country:US
Mailing Address - Phone:850-877-8174
Mailing Address - Fax:844-261-6839
Practice Address - Street 1:113 W HANSELL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6664
Practice Address - Country:US
Practice Address - Phone:229-226-3060
Practice Address - Fax:855-460-8658
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2022-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9114730363A00000X
GA008291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant