Healthcare Provider Details

I. General information

NPI: 1255617841
Provider Name (Legal Business Name): ASHLEY B. BAKER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COLONY PARK DR STE 300
CUMMING GA
30041
US

IV. Provider business mailing address

P.O. BOX 4551 PAULION PSYCHOLOGICAL SERVICES
SUWANEE GA
30024
US

V. Phone/Fax

Practice location:
  • Phone: 678-679-7118
  • Fax: 678-679-7112
Mailing address:
  • Phone: 678-679-7118
  • Fax: 678-679-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS-P000218
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003511
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: