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NPI Code Detail

MEDICARE: DIEDRA MICHELLE JOSEPH BAKER MD

MEDICARE: DIEDRA MICHELLE JOSEPH BAKER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician97544GA

General Provider Information

NPI Number : 1740804848
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIEDRA MICHELLE JOSEPH BAKER MD
Provider Business Mailing Address
First Line : 1 MEADOWS PKWY
Second Line :
City : VIDALIA
State : GA
Zip : 30474-8759
Country : US
Telephone Number : 912-535-5555
Fax Number :
Provider Business Practice Location Address
First Line : 1 MEADOWS PKWY
Second Line :
City : VIDALIA
State : GA
Zip : 30474-8759
Country : US
Telephone Number : 912-535-5555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2020
Last Update Date : 06/03/2026

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