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General NPI Number Information
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NPI Number | 1821572447
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Entity Type | Organization
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Legal Business Name | CIES GLOBAL - GEORGIA LLC
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 780 CANTON RD NE STE 205
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City | MARIETTA
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State | GA
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Zip | 30060-7242
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Country | US
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Telephone | 678-324-0222
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Fax | 770-726-7916
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Provider Business Mailing Address
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Address Line | 780 CANTON RD NE STE 205
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City | MARIETTA
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State | GA
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Zip | 30060-7242
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Country | US
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Telephone | 678-324-0222
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Fax | 770-726-7916
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ANTONIO BAUTE
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Credential | MD
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Telephone | 678-324-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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