Provider Demographics
NPI:1992808463
Name:BAEHLER, RICHARD W (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:BAEHLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 COWLES CLINC WAY STE W-200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-4539
Mailing Address - Country:US
Mailing Address - Phone:706-923-2002
Mailing Address - Fax:706-999-1540
Practice Address - Street 1:1000 COWLES CLINC WAY STE W-200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-4539
Practice Address - Country:US
Practice Address - Phone:706-923-2002
Practice Address - Fax:706-999-1540
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17721207RN0300X
GA059429207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64177215Medicaid
C64680Medicare UPIN
0040901Medicare ID - Type Unspecified
KY64177215Medicaid
GA202I396221Medicare PIN