MEDICARE: DR. MICHAEL WARREN BAIN 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	2084P0804X	Child & Adolescent Psychiatry Physician	GA LIC 36680	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GA LIC 036680	OTHER	GA	GEORGIA MEDICAL LICENSE

General Provider Information

NPI Number	:	1447258975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WARREN BAIN MD

Provider Business Mailing Address
First Line	:	P.O. BOX 88423
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30356
Country	:	US
Telephone Number	:	404-261-8291
Fax Number	:	404-261-5107

Provider Business Practice Location Address
First Line	:	3525 PIEDMONT RD NE
Second Line	:	BLDG 6, SUITE 210
City	:	ATLANTA
State	:	GA
Zip	:	30305-1578
Country	:	US
Telephone Number	:	404-261-8291
Fax Number	:	404-261-5107

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/15/2016

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