Healthcare Provider Details

I. General information

NPI: 1508071515
Provider Name (Legal Business Name): TRACEY L BAKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 S HILL ST
GRIFFIN GA
30224-4830
US

IV. Provider business mailing address

202 LARCOM LN
GRIFFIN GA
30224-4905
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-5407
  • Fax: 770-228-5408
Mailing address:
  • Phone: 404-557-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN097754
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN097754
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: