WAYNE L BAKOTIC (NPI# 1295798320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295798320 |
| Entity Type | Individual |
| Full Name | WAYNE L BAKOTIC |
| Credential | D.O. |
| Practice Address |
114 Mimosa Dr Suite C Thomasville GA 31792-6677 |
| Mailing Address |
Po Box 2717 Thomasville GA 31799-2717 |
| Practice Telephone | 2292286496 |
| Practice Fax Number | 2292286510 |
| Mailing Telephone | 2292286496 |
| Mailing Fax Number | 2292286510 |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2008-05-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZD0900X |
Pathology Specialization: Dermatopathology |
051017 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 075954118A | 05 |
| Street Address |
114 MIMOSA DR SUITE C |
| City | THOMASVILLE |
| State | GA |
| Zip Code | 31792-6677 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730564998 | Archbold Medical Group, Inc | Psychiatry & Neurology | 114 Mimosa Dr, Suite C, Thomasville, GA 31792-6677 | 2015-07-29 |
| 1225257132 | South Georgia Physical Medicine and Rehabilitation | Specialist | 114 Mimosa Dr, Thomasville, GA 31792-6677 | 2007-04-25 |
| 1902932593 | Jemeka S Christian | Physician Assistant | 114 Mimosa Dr, Jdamh -- Apogee Medical Group, Thomasville, GA 31792-5739 | 2007-02-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245739879 | Georgia Pines Community Service Board | Community/Behavioral Health | 407 Cloverdale Drive, Thomasville, GA 31792 | 2018-02-09 |
| 1932613551 | Diana Diaz | Physician Assistant | 2705 E Pinetree Blvd Ste A, Thomasville, GA 31792 | 2017-11-17 |
| 1194249425 | Bobbie Frazier | Contractor | 400 Cloverdale Dr, Thomasville, GA 31792 | 2017-07-28 |
| 1598132292 | Southern Scripts, LLC | Pharmacy | 501 Gordon Avenue, Thomasville, GA 31792 | 2015-08-28 |
| 1508248915 | Elizabeth Nicole Keen | Behavioral Analyst | 121 Covington Ave Apt 9, Thomasville, GA 31792 | 2015-06-22 |
| 1417341579 | Sheila L Stanley | Counselor | 301 Summercreek Cove, Thomasville, GA 31792 | 2015-03-26 |
| 1457749301 | Ashley Lamb | Speech-Language Pathologist | 1203 East Jackson Street, Thomasville, GA 31792 | 2014-12-30 |
| 1831403880 | Somnoquest | Durable Medical Equipment & Medical Supplies | 556 Hall Road, Thomasville, GA 31792 | 2010-08-02 |
| 1508000183 | Kashyap B Choksi | Internal Medicine | 100 Mimosa Drive 2nd Floor, Thomasville, GA 31792 | 2009-04-27 |
| 1205008786 | Mark J Glaccum | Chiropractor | 415 Gordon Avenue, Thomasville, GA 31792 | 2008-03-25 |
| Find all providers in zip 31792 | ||||
| Taxonomy Code | 207ZD0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Dermatopathology |
| A dermatopathologist is an expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of light microscopy, electron microscopy, and fluorescence microscopy. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source added] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. A subspecialty certificate was first issued by the ABMS in 1974. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336102508 | Wesley W Simms | Pathology | 119 W Hill St, Thomasville, GA 31792-6618 | 2006-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871630350 | Seth Ian Rosenthal | Pathology | 1901 Phoenix Blvd Ste 210, Atlanta, GA 30349-5062 | 2007-01-31 |
| 1780623785 | Jessie Lee | Pathology | 175 White St Nw, Suite 370, Marietta, GA 30060-1053 | 2006-06-05 |
| 1134193774 | Drazen M Jukic | Pathology | 5400 Sutlive St, Suite 3, Savannah, GA 31405-4721 | 2006-02-13 |
| 1639158389 | Scott M Acker | Pathology | 6240 Shiloh Rd Ste B, Alpharetta, GA 30005-8347 | 2006-01-11 |
| 1295710754 | Bradley W. Bakotic | Pathology | 2001 Westside Parkway, Suite 290, Alpharetta, GA 30004-8514 | 2005-12-07 |
| 1093797144 | Michael J Palko IIi | Pathology | 510 E Oglethorpe Hwy, Hinesville, GA 31313 | 2005-11-15 |
| 1053392191 | Ling Chen | Pathology | 1951 Clairmont Rd, Decatur, GA 30033-3415 | 2005-11-07 |
| 1649270885 | Jordan H. Berne | Pathology | 6095 Barfield Rd Ne, Suite 200, Atlanta, GA 30328-4408 | 2005-07-29 |
| 1588667380 | Christopher J Kligora | Pathology | 311 W 8th St Ne, Rome, GA 30165-2723 | 2005-05-24 |
| 1912900697 | Steve M Covington IIi | Pathology | 2701 N Decatur Rd, Decatur, GA 30033-5918 | 2005-05-24 |
| Find all providers with the same taxonomy | ||||
| City | THOMASVILLE |
| Zip Code | 31792 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.