Healthcare Provider Details

I. General information

NPI: 1053679126
Provider Name (Legal Business Name): BARATH RAM BADRINATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 10/07/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

IV. Provider business mailing address

2675 N DECATUR RD STE 512
DECATUR GA
30033-6134
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-2930
  • Fax:
Mailing address:
  • Phone: 404-501-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.136243
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number79387
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: