MEDICARE: MR. MICHAEL LESLEY BARON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0033273	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104820125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL LESLEY BARON DO

Provider Business Mailing Address
First Line	:	1505 LILBURN STONE MTN RD
Second Line	:	STE 100
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-1857
Country	:	US
Telephone Number	:	770-469-1711
Fax Number	:	770-469-1837

Provider Business Practice Location Address
First Line	:	1505 LILBURN STONE MTN RD
Second Line	:	STE 100
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-1857
Country	:	US
Telephone Number	:	770-469-1711
Fax Number	:	770-469-1837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	11/23/2011

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