Provider Demographics
NPI:1225011075
Name:BAYNHAM, STEPHEN ALTON (MD, FAAO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALTON
Last Name:BAYNHAM
Suffix:
Gender:M
Credentials:MD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 GREAT OAKS DR
Mailing Address - Street 2:STE 101
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8211
Mailing Address - Country:US
Mailing Address - Phone:770-267-4561
Mailing Address - Fax:770-267-8061
Practice Address - Street 1:517 GREAT OAKS DR
Practice Address - Street 2:STE 101
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8211
Practice Address - Country:US
Practice Address - Phone:770-267-4561
Practice Address - Fax:770-267-8061
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048208207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18BDFRTMedicare PIN
GAH15746Medicare UPIN