Basic Information
| Provider Information | |||||||||
| NPI: | 1730316001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAISE-SHUMAN | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14089 ABERCORN ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314191966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123502121 | ||||||||
| FaxNumber: | 9123502145 | ||||||||
| Practice Location | |||||||||
| Address1: | 14089 ABERCORN ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314191966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123502121 | ||||||||
| FaxNumber: | 9123502145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2009 | ||||||||
| LastUpdateDate: | 11/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 005598 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 003134349C | 05 | GA | MEDICAID | 003134349D | 05 | GA | MEDICAID | 003134349A | 05 | GA | MEDICAID | 003134349B | 05 | GA | MEDICAID | P01195450 | 01 | GA | RAILROAD MEDICARE | OTHER |