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General NPI Number Information
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NPI Number | 1962477380
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Entity Type | Individual
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Provider Name | GREGG A BAUER M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 699 CHURCH ST NE SUITE 220
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City | MARIETTA
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State | GA
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Zip | 30060-1116
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Country | US
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Telephone | 770-422-8505
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Fax | 770-424-7449
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Provider Business Mailing Address
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Address Line | 699 CHURCH ST NE SUITE 220
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City | MARIETTA
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State | GA
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Zip | 30060-1116
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Country | US
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Telephone | 770-422-8505
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Fax | 770-424-7449
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 034108
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License Number State | GA
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