Healthcare Provider Details

I. General information

NPI: 1437664372
Provider Name (Legal Business Name): JULIE TAYLOR BAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE STE H100
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

20 TEE PEE ROW
SHARPSBURG GA
30277-4629
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-4310
  • Fax:
Mailing address:
  • Phone: 423-797-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8654
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: