Individual
ALYSSA BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
777 HEMLOCK STREET LN # 165, MACON, GA 31201-2168
(478) 633-1634
Mailing address
777 HEMLOCK STREET LN # 165, MACON, GA 31201-2168
(478) 633-1634
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
16002
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2024
Last updated
05/29/2024
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