Provider Demographics
NPI:1255718789
Name:GRANBERRY-BAKER, YOLANDA (DC)
Entity type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:
Last Name:GRANBERRY-BAKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 OVERLOOK PKWY
Mailing Address - Street 2:#618
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5796
Mailing Address - Country:US
Mailing Address - Phone:407-429-9243
Mailing Address - Fax:
Practice Address - Street 1:1091 OVERLOOK PKWY
Practice Address - Street 2:#618
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5796
Practice Address - Country:US
Practice Address - Phone:407-429-9243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor