Healthcare Provider Details

I. General information

NPI: 1457500233
Provider Name (Legal Business Name): MARK BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 W DOYLE ST
TOCCOA GA
30577-1791
US

IV. Provider business mailing address

126 WILD HORSE COVE CIR
CLEVELAND GA
30528-2231
US

V. Phone/Fax

Practice location:
  • Phone: 706-827-9937
  • Fax: 706-827-0085
Mailing address:
  • Phone: 706-348-7542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: