Healthcare Provider Details

I. General information

NPI: 1861500084
Provider Name (Legal Business Name): KAREN MARIE BAKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COWLES CLINC WAY SUITE 1
GREENSBORO GA
30642-5285
US

IV. Provider business mailing address

1835 SAVOY DR SUITE 300
ATLANTA GA
30341-1072
US

V. Phone/Fax

Practice location:
  • Phone: 706-454-0159
  • Fax: 706-454-0101
Mailing address:
  • Phone: 770-495-3396
  • Fax: 770-495-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN078399
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: