Provider Demographics
NPI:1396735155
Name:BAKER, CHESTER RILEY (NP RN CS)
Entity type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:RILEY
Last Name:BAKER
Suffix:
Gender:M
Credentials:NP RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 B MAGNOLIA LANE
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531
Mailing Address - Country:US
Mailing Address - Phone:706-776-3070
Mailing Address - Fax:706-776-3788
Practice Address - Street 1:130 MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-2241
Practice Address - Country:US
Practice Address - Phone:706-776-3070
Practice Address - Fax:706-776-3788
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA146348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA035805515AMedicaid
GAS94082Medicare UPIN
GA50BBDFRMedicare ID - Type Unspecified