Provider Demographics
NPI:1356452122
Name:BAKER, SUZANNE PAULETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:PAULETTE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:PAULETTE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1780 CENTURY BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3399
Mailing Address - Country:US
Mailing Address - Phone:404-636-6607
Mailing Address - Fax:404-315-9744
Practice Address - Street 1:1780 CENTURY BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3399
Practice Address - Country:US
Practice Address - Phone:404-636-6607
Practice Address - Fax:404-315-9744
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001718103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR99012Medicare ID - Type UnspecifiedPSYCHOLOGIST