Healthcare Provider Details

I. General information

NPI: 1467532523
Provider Name (Legal Business Name): CONSTANCE BALDWIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/14/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK RD STE 400
ATLANTA GA
30342-4794
US

IV. Provider business mailing address

5445 MERIDIAN MARK RD STE 400
ATLANTA GA
30342-4794
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax: 404-785-9022
Mailing address:
  • Phone: 404-785-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number059597
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: