Provider Demographics
NPI:1811159395
Name:BAI, JITAO
Entity type:Individual
Prefix:
First Name:JITAO
Middle Name:
Last Name:BAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 INDEPENDENCE SQ STE A
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5164
Mailing Address - Country:US
Mailing Address - Phone:770-393-9090
Mailing Address - Fax:
Practice Address - Street 1:1820 INDEPENDENCE SQ STE A
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5164
Practice Address - Country:US
Practice Address - Phone:770-393-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist