Champ  L  Baker  III  MD
Contract Details
Hughston Clinic--Valdosta
Facility name
Provider ID
P000000077
NPI
1912128448
Tax ID
581155460
Effective Date
4/15/2010
Last Updated
9/22/2014
Direct Contract
Yes
Term Date
5/16/2013
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_140
Location Details
Address
4340 Kings Way
Valdosta, GA 31602
United States
County
Lowndes
Phone
2293339736 (Phone)
Billing Details
Address
P.O. Box 848249
Boston, MA 02284
Billing Phone
7063246661
Specialty Type
Surgery, Orthopedic
Map
Address