Healthcare Provider Details

I. General information

NPI: 1356991251
Provider Name (Legal Business Name): RACHAEL VICKIE BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 GEORGE C WILSON DR
AUGUSTA GA
30909-4501
US

IV. Provider business mailing address

3696 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 706-941-8206
  • Fax: 833-481-3460
Mailing address:
  • Phone: 706-736-1830
  • Fax: 706-650-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09505
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13926
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: