Provider Demographics
NPI:1902229701
Name:BAKER, LAWRENCE DAVID (MDM)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DAVID
Last Name:BAKER
Suffix:
Gender:M
Credentials:MDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 MOUNT WILKINSON PKWY SE UNIT 613
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3655
Mailing Address - Country:US
Mailing Address - Phone:404-610-7709
Mailing Address - Fax:
Practice Address - Street 1:2950 MOUNT WILKINSON PKWY SE UNIT 613
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3655
Practice Address - Country:US
Practice Address - Phone:404-610-7709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA155702084P0800X
NC1084172084P0800X
MS178942084P0800X
FLME928602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry