MEDICARE: TONYA WOODALL BAKER, D.M.D., INC.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10874	GA

General Provider Information

NPI Number	:	1518056662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TONYA WOODALL BAKER, D.M.D., INC.

Provider Business Mailing Address
First Line	:	190 CURTIS PKWY NE
Second Line	:	SUITE A
City	:	CALHOUN
State	:	GA
Zip	:	30701-2062
Country	:	US
Telephone Number	:	706-602-0540
Fax Number	:	706-602-2879

Provider Business Practice Location Address
First Line	:	190 CURTIS PKWY NE
Second Line	:	SUITE A
City	:	CALHOUN
State	:	GA
Zip	:	30701-2062
Country	:	US
Telephone Number	:	706-602-0540
Fax Number	:	706-602-2879

Authorized Official
Title or Position	:	PRESIDENT/ORTHODONTIST
Name	:	DR. TONYA WOODALL BAKER
Credential	:	D.M.D.
Telephone Number	:	706-602-0540

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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