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NPI Code Detail

MEDICARE: JACQUELINE R BAKER PA

MEDICARE: JACQUELINE R BAKER PA
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
1363A00000XPhysician Assistant5954GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11699976332OTHERGAGROUP NPI
24759OTHERGAGROUP

General Provider Information

NPI Number : 1477853539
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE R BAKER PA
Provider Business Mailing Address
First Line : PO BOX 15225
Second Line :
City : LOVES PARK
State : IL
Zip : 61132-5225
Country : US
Telephone Number : 815-713-2600
Fax Number : 815-654-8020
Provider Business Practice Location Address
First Line : 4328 ARMOUR RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-5204
Country : US
Telephone Number : 706-507-1213
Fax Number : 706-507-1217
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2010
Last Update Date : 12/02/2014

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Directions to “ JACQUELINE R BAKER PA” Practice Location

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