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General NPI Number Information
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NPI Number | 1972987394
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Entity Type | Individual
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Provider Name | ANNA MAKENZIE BAKER O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 211 LOVE AVE
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City | TIFTON
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State | GA
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Zip | 31794-4453
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Country | US
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Telephone | 229-382-9751
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Fax |
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Provider Business Mailing Address
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Address Line | 1323 4TH ST SW
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City | MOULTRIE
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State | GA
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Zip | 31768-5818
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Country | US
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Telephone | 229-873-1274
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002889
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License Number State | GA
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