Provider Demographics
NPI:1629061395
Name:BAUTE, ANTONIO V (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:V
Last Name:BAUTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FOX CHASE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2491
Mailing Address - Country:US
Mailing Address - Phone:352-617-9649
Mailing Address - Fax:770-382-0247
Practice Address - Street 1:40 FOX CHASE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2491
Practice Address - Country:US
Practice Address - Phone:770-382-0185
Practice Address - Fax:770-382-0247
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19142207R00000X, 207UN0901X, 207UN0902X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000202705AKMedicaid
GA000202705AJMedicaid
D39369Medicare UPIN
GA000202705AKMedicaid