Provider Demographics
NPI:1831184357
Name:BAUCOM, MARK FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:FRANCIS
Last Name:BAUCOM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 206
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1711
Mailing Address - Country:US
Mailing Address - Phone:404-844-0496
Mailing Address - Fax:404-844-0499
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:STE 206
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1703
Practice Address - Country:US
Practice Address - Phone:404-844-0496
Practice Address - Fax:404-943-9464
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2023-12-13
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Provider Licenses
StateLicense IDTaxonomies
GA034773207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05375Medicare UPIN
GA07BDCNNMedicare ID - Type Unspecified