Healthcare Provider Details

I. General information

NPI: 1346250362
Provider Name (Legal Business Name): SCOTT DAVID BADER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/07/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 PRESTON RIDGE RD DEPT OF PEDIATRICS
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: 404-365-0966
  • Fax: 732-564-0212
Mailing address:
  • Phone: 404-364-7070
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA69791
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG5928
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: