Healthcare Provider Details

I. General information

NPI: 1295021251
Provider Name (Legal Business Name): MATTHEW PAUL BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 JENNINGS MILL RD STE 110
WATKINSVILLE GA
30677-7241
US

IV. Provider business mailing address

1765 OLD WEST BROAD ST BLDG 2-200
ATHENS GA
30606-2887
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-5880
  • Fax:
Mailing address:
  • Phone: 706-549-1663
  • Fax: 706-546-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number78216
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: