Healthcare Provider Details

I. General information

NPI: 1477853539
Provider Name (Legal Business Name): JACQUELINE R BAKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2010
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 PEACHTREE PKWY STE 4226
CUMMING GA
30041-7439
US

IV. Provider business mailing address

410 PEACHTREE PKWY STE 4226
CUMMING GA
30041-7439
US

V. Phone/Fax

Practice location:
  • Phone: 678-341-9881
  • Fax: 678-341-9883
Mailing address:
  • Phone: 678-341-9881
  • Fax: 678-341-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5954
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: