Healthcare Provider Details

I. General information

NPI: 1871296038
Provider Name (Legal Business Name): LEMUEL BAJO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CAMPBELL HILL ST NW STE 103
MARIETTA GA
30060-1386
US

IV. Provider business mailing address

611 CAMPBELL HILL ST NW STE 103
MARIETTA GA
30060-1386
US

V. Phone/Fax

Practice location:
  • Phone: 404-435-6672
  • Fax:
Mailing address:
  • Phone: 770-435-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number113431
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: