Provider Demographics
NPI:1962477380
Name:BAUER, GREGG A (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:A
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:699 CHURCH ST NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1116
Mailing Address - Country:US
Mailing Address - Phone:770-422-8505
Mailing Address - Fax:770-424-7449
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1116
Practice Address - Country:US
Practice Address - Phone:770-422-8505
Practice Address - Fax:770-424-7449
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2017-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034108207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA323730OtherWELLCARE
GA481285OtherBCBS
GA0700203OtherUNITED HEALTHCARE
FL5884019OtherAETNA
GA10056227OtherAMERIGROUP
GA000532067CMedicaid
GA000532067EMedicaid
GA1865269-001OtherCIGNA
GA000532067GMedicaid
GA0700203OtherUNITED HEALTHCARE
GA16BDDXQMedicare PIN