Provider Demographics
NPI:1346202835
Name:BAIRAN, ROMANA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMANA
Middle Name:Y
Last Name:BAIRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-1760
Mailing Address - Country:US
Mailing Address - Phone:352-262-4180
Mailing Address - Fax:
Practice Address - Street 1:607 N IRWIN AVE
Practice Address - Street 2:STE C
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-5009
Practice Address - Country:US
Practice Address - Phone:229-468-5020
Practice Address - Fax:229-468-5024
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000921412DMedicaid
GA000921412CMedicaid
GAGRP2584Medicare PIN
GA202G700580Medicare PIN
GA000921412CMedicaid