Individual
DIANE S BAIRAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-3941
(706) 721-7113
Mailing address
1120 15TH ST, STE BI1056, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
001876
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0146PA
—
SC
05
—
100000104A
—
GA
Enumeration date
08/30/2006
Last updated
05/15/2019
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