Provider Demographics
NPI:1497005599
Name:BAKER, ANGELA C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:C
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 GRANDVIEW AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1819
Mailing Address - Country:US
Mailing Address - Phone:404-234-4884
Mailing Address - Fax:
Practice Address - Street 1:3050 PEACHTREE RD NW
Practice Address - Street 2:SUITE P-5
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2212
Practice Address - Country:US
Practice Address - Phone:404-214-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant