Basic Information
| Provider Information | |||||||||
| NPI: | 1629061395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUTE | ||||||||
| FirstName: | ANTONIO | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 FOX CHASE | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301202491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703820185 | ||||||||
| FaxNumber: | 7703820247 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 FOX CHASE | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301202491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703820185 | ||||||||
| FaxNumber: | 7703820247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 11/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 19142 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207UN0901X | 19142 | GA | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207UN0902X | 19142 | GA | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Imaging & Therapy | 207R00000X | 19142 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000202705AJ | 05 | GA | MEDICAID | 000202705AK | 05 | GA | MEDICAID |