MEDICARE: DR. MCKINLEY THEODORE BAIN

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	046826	GA
2	207R00000X	Internal Medicine Physician	046826	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	:	1235145061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MCKINLEY THEODORE BAIN

Provider Business Mailing Address
First Line	:	1930 POWDER SPRINGS RD SW
Second Line	:	SUITE 1120
City	:	MARIETTA
State	:	GA
Zip	:	30064-4324
Country	:	US
Telephone Number	:	770-427-7800
Fax Number	:	470-427-6565

Provider Business Practice Location Address
First Line	:	1930 POWDER SPRINGS RD SW
Second Line	:	SUITE 1120
City	:	MARIETTA
State	:	GA
Zip	:	30064-4324
Country	:	US
Telephone Number	:	770-427-7800
Fax Number	:	470-427-6565

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	05/16/2025

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