Healthcare Provider Details

I. General information

NPI: 1447258975
Provider Name (Legal Business Name): MICHAEL WARREN BAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 PIEDMONT RD NE BLDG 6, SUITE 210
ATLANTA GA
30305-1578
US

IV. Provider business mailing address

P.O. BOX 88423
ATLANTA GA
30356
US

V. Phone/Fax

Practice location:
  • Phone: 404-261-8291
  • Fax: 404-261-5107
Mailing address:
  • Phone: 404-261-8291
  • Fax: 404-261-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberGA LIC 36680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: