Provider Demographics
NPI:1962877001
Name:BALDWIN, COURTNEY (CSA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSA
Mailing Address - Street 1:901 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5183
Mailing Address - Country:US
Mailing Address - Phone:912-281-9105
Mailing Address - Fax:
Practice Address - Street 1:2403 SPURGEON ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501
Practice Address - Country:US
Practice Address - Phone:912-281-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA144370246ZS0410X
GA4601246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist