Healthcare Provider Details

I. General information

NPI: 1285643734
Provider Name (Legal Business Name): GREGORY ALAN BAKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MARKET ST
CHATSWORTH GA
30705-2911
US

IV. Provider business mailing address

103 E MARKET ST
CHATSWORTH GA
30705-2911
US

V. Phone/Fax

Practice location:
  • Phone: 706-695-7790
  • Fax: 706-695-9003
Mailing address:
  • Phone: 706-695-7790
  • Fax: 706-695-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4731
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: