Provider Demographics
NPI:1740482850
Name:BARITEAU, JASON TYLER (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TYLER
Last Name:BARITEAU
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 1:59 EXECUTIVE PARK S
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2208
Mailing Address - Country:US
Mailing Address - Phone:404-778-5277
Mailing Address - Fax:404-778-3538
Practice Address - Street 1:59 EXECUTIVE PARK S
Practice Address - Street 2:SUITE 2000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-778-5277
Practice Address - Fax:404-778-3538
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01073207X00000X
RI13840207X00000X
TXP5595207XX0004X
GA070339207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX316435YKY6Medicare PIN
TX316435YKTPMedicare PIN