Provider Demographics
NPI:1043941099
Name:BAKER, JEREMY SETH (NP-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:SETH
Last Name:BAKER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 LUKE ST SW
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-8016
Mailing Address - Country:US
Mailing Address - Phone:706-331-6705
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL CT
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2077
Practice Address - Country:US
Practice Address - Phone:706-602-8200
Practice Address - Fax:706-602-1354
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily