Provider Demographics
NPI:1881844033
Name:BAKER, GEORGIA M (NP)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 YOUREE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5127
Mailing Address - Country:US
Mailing Address - Phone:318-212-3610
Mailing Address - Fax:318-212-3709
Practice Address - Street 1:7925 YOUREE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5127
Practice Address - Country:US
Practice Address - Phone:318-212-3610
Practice Address - Fax:318-212-3709
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2014-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP05611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3A840CR96OtherMEDICARE PTAN