Doctor Name: | MR. CHESTER RILEY BAKER |
NPI Number: | 1396735155 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP RN CS |
License Number: | 146348 |
Business Practice Address: | 130 Magnolia Ln Cornelia, GA - 305312241 |
Business Phone Number: | 7067763070 |
Business Fax Number: | 7067763788 |
Mailing Address: | 130 B Magnolia Lane, CORNELIA |
State: | GA |
Postal Code: | 30531 |
Phone Number: | 7067763070 |
Fax Number: | 7067763788 |
NPI Enumeration Date: | 10/24/2005 |
NPI Last Update Date: | 09/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 146348 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |