MEDICARE: JOHN BAEK MD

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	208000000X	Pediatrics Physician	12901	GA

General Provider Information

NPI Number	:	1194394932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BAEK MD

Provider Business Mailing Address
First Line	:	1945 CHATTAHOOCHEE DR
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-7937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1285 HEMBREE RD STE 100
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-5715
Country	:	US
Telephone Number	:	770-442-1050
Fax Number	:

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

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	09/26/2024

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Directions to “ JOHN BAEK MD” Practice Location

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