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General NPI Number Information
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NPI Number | 1093793416
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Entity Type | Individual
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Provider Name | KELLI INGRAM BAENDER M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 3379 PEACHTREE RD. NE SUITE 500
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City | ATLANTA
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State | GA
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Zip | 30326-1418
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Country | US
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Telephone | 404-355-5484
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Fax | 404-355-5787
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Provider Business Mailing Address
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Address Line | 3379 PEACHTREE RD. NE SUITE 500
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City | ATLANTA
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State | GA
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Zip | 30326-1418
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Country | US
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Telephone | 404-355-5484
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Fax | 404-355-5787
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 60105
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 60105
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License Number State | GA
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