Healthcare Provider Details

I. General information

NPI: 1114937471
Provider Name (Legal Business Name): SAMUEL THOMAS BAKER MDIV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOMMY BAKER

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S #125
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

10 BAKER CT
LEBANON TN
37087-2677
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-5362
  • Fax:
Mailing address:
  • Phone: 615-443-2730
  • Fax: 615-443-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: