MEDICARE: DR. DIANA BAEKEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1093166084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA BAEKEY

Provider Business Mailing Address
First Line	:	53 PERIMETER CTR E STE 350
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30346-2204
Country	:	US
Telephone Number	:	866-750-5554
Fax Number	:	678-809-2530

Provider Business Practice Location Address
First Line	:	53 PERIMETER CTR E STE 350
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30346-2204
Country	:	US
Telephone Number	:	866-750-5554
Fax Number	:	678-809-2530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	06/30/2016

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Directions to “ DR. DIANA BAEKEY ” Practice Location

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