Provider Demographics
NPI:1376237941
Name:BAKER, CORRIE ALEXIS (PAC)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:ALEXIS
Last Name:BAKER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 JOHNSON FERRY RD STE 820
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1608
Mailing Address - Country:US
Mailing Address - Phone:404-252-9307
Mailing Address - Fax:404-252-5839
Practice Address - Street 1:980 JOHNSON FERRY RD STE 820
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1608
Practice Address - Country:US
Practice Address - Phone:404-252-9307
Practice Address - Fax:404-252-5839
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant