Provider Demographics
NPI:1265512875
Name:BAUERBAND, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BAUERBAND
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:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:355 CLEAR CREEK PKWY STE 1003
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4271
Practice Address - Country:US
Practice Address - Phone:706-356-0780
Practice Address - Fax:706-356-0781
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32692207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000503544BMedicaid
GA20270G2280OtherMEDICARE
GA202I166498OtherMEDICARE
GA000503544BMedicaid
GA00503544AMedicaid
GA202G707686OtherMEDICARE B
GA202G707686OtherMEDICARE B
GA00503544AMedicaid