Healthcare Provider Details

I. General information

NPI: 1760344428
Provider Name (Legal Business Name): STEVEN BASKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 PEACHTREE INDUSTRIAL BLVD STE 400
BERKELEY LAKE GA
30071-5735
US

IV. Provider business mailing address

4720 PEACHTREE INDUSTRIAL BLVD BLDG 400
BERKELEY LAKE GA
30071-5735
US

V. Phone/Fax

Practice location:
  • Phone: 404-900-9583
  • Fax:
Mailing address:
  • Phone: 404-900-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: