Provider Demographics
NPI:1255617841
Name:BAKER, ASHLEY B (PSYD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:B
Last Name:BAKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4551
Mailing Address - Street 2:PAULION PSYCHOLOGICAL SERVICES
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-679-7118
Mailing Address - Fax:678-679-7112
Practice Address - Street 1:101 COLONY PARK DR
Practice Address - Street 2:STE 300
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:678-679-7118
Practice Address - Fax:678-679-7112
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPS-P000218103TC0700X
GAPSY003511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA03116200AMedicaid