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General NPI Number Information
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NPI Number | 1245328962
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Entity Type | Individual
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Provider Name | ELEAZAR BAKER SA
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8737 DUNWOODY PLACE SUITE 4
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City | ATLANTA
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State | GA
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Zip | 30350
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Country | US
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Telephone | 770-650-8112
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Fax | 770-650-8505
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Provider Business Mailing Address
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Address Line | PO BOX 422444
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City | ATLANTA
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State | GA
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Zip | 30291
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Country | US
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Telephone | 678-566-2780
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Fax | 678-566-2785
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2707
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License Number State | GA
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