Healthcare Provider Details

I. General information

NPI: 1316236045
Provider Name (Legal Business Name): GRIFFIN RICHARD BAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S BROAD ST
THOMASVILLE GA
31792-6107
US

IV. Provider business mailing address

704 S BROAD ST
THOMASVILLE GA
31792-6107
US

V. Phone/Fax

Practice location:
  • Phone: 229-584-5760
  • Fax: 229-584-5945
Mailing address:
  • Phone: 229-584-5760
  • Fax: 229-584-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number110583
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: