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General NPI Number Information
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NPI Number | 1508071515
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Entity Type | Individual
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Provider Name | TRACEY L BAKER FNP
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Gender | Female
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Dates
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Enumeration Date | 05/12/2007
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Last Update Date | 11/08/2025
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Provider Practice Location Address
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Address Line | 747 S HILL ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4830
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Country | US
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Telephone | 770-228-5407
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Fax | 770-228-5408
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Provider Business Mailing Address
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Address Line | 202 LARCOM LN
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City | GRIFFIN
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State | GA
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Zip | 30224-4905
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Country | US
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Telephone | 404-557-2604
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | RN097754
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN097754
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License Number State | GA
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