MEDICARE: BAUMRIND RETINA, LLC

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1487313839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAUMRIND RETINA, LLC

Provider Business Mailing Address
First Line	:	1425 ELLSWORTH INDUSTRIAL BLVD NW STE 36
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4154
Country	:	US
Telephone Number	:	404-512-1590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 ELLSWORTH INDUSTRIAL BLVD NW STE 36
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4154
Country	:	US
Telephone Number	:	404-512-1590
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BENJAMIN ROSEN BAUMRIND
Credential	:	MD
Telephone Number	:	404-512-1590

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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