Individual
DR. KELLI INGRAM BAENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
150 E PONCE DE LEON AVE STE 150, DECATUR, GA 30030-2566
(404) 566-5056
(404) 566-5046
Mailing address
216 GLENDALE AVE, DECATUR, GA 30030-1918
(678) 480-4095
(404) 566-5046
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
60105
GA
207NS0135X
Procedural Dermatology Physician
Primary
60105
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86080015085259A972
TRIWEST
AZ
05
—
894057
—
AZ
01
—
P00231283
RAILROAD MEDICARE
AZ
Enumeration date
01/05/2006
Last updated
05/13/2026
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