| Doctor Name: | MR. RICHARD GLEN BAKER |
| NPI Number: | 1699915868 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | RN 132955NP |
| Business Practice Address: | 130 Moore St Omega, GA - 317753075 |
| Business Phone Number: | 2295286500 |
| Business Fax Number: | 2295283283 |
| Mailing Address: | 130 Moore St, Po Box 809 OMEGA |
| State: | GA |
| Postal Code: | 317753075 |
| Phone Number: | 2295286500 |
| Fax Number: | 2295283283 |
| NPI Enumeration Date: | 03/02/2009 |
| NPI Last Update Date: | 04/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN 132955NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |