Organization
ASC OF BAUCOM & MINA DERM SURGERY JOHNS CREEK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK F BAUCOM MD (OWNER)
(404) 844-0496
Entity
Organization
Contact information
Practice address
10750 MEDLOCK BRIDGE RD STE 102, JOHNS CREEK, GA 30097-1705
(470) 545-2124
(404) 844-0499
Mailing address
5555 PEACHTREE DUNWOODY RD STE 206, ATLANTA, GA 30342-1711
(404) 844-0496
(404) 844-0499
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
06/07/2023
Last updated
12/13/2023
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