Healthcare Provider Details

I. General information

NPI: 1326513102
Provider Name (Legal Business Name): BRITTANY DENISE BAKER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD RM 3B250
DECATUR GA
30033-4004
US

IV. Provider business mailing address

2443 TOLLIVER DR
ELLENWOOD GA
30294-6260
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone: 770-653-5863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07767
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number07767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: