Healthcare Provider Details

I. General information

NPI: 1689687188
Provider Name (Legal Business Name): ALEXANDER G BAILON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/13/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 PRESTON RIDGE RD INTERNAL MEDICINE HEALTH CARE TEAM A
ALPHARETTA GA
30005-3821
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 770-663-3122
  • Fax: 770-663-3149
Mailing address:
  • Phone: 404-364-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number037133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: