Provider Demographics
NPI:1821572447
Name:CIES GLOBAL - GEORGIA LLC
Entity Type:Organization
Organization Name:CIES GLOBAL - GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-324-0222
Mailing Address - Street 1:780 CANTON RD NE STE 205
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7242
Mailing Address - Country:US
Mailing Address - Phone:678-324-0222
Mailing Address - Fax:770-726-7916
Practice Address - Street 1:780 CANTON RD NE STE 205
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7242
Practice Address - Country:US
Practice Address - Phone:678-324-0222
Practice Address - Fax:770-726-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty