Provider Demographics
NPI:1649224668
Name:BAKER, RENEATHIA PRIMUS (MD)
Entity Type:Individual
Prefix:
First Name:RENEATHIA
Middle Name:PRIMUS
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RENEATHIA
Other - Middle Name:LASHANNE
Other - Last Name:PRIMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT ROAD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-949-5019
Mailing Address - Fax:404-364-4985
Practice Address - Street 1:2400 MOUNT ZION PKWY
Practice Address - Street 2:SOUTHWOOD MEDICAL OFFICE DEPARTMENT OF PEDIATRICS
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-603-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics