Provider Demographics
NPI:1811015845
Name:BAKER, DAVID L (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6561
Mailing Address - Country:US
Mailing Address - Phone:706-922-0298
Mailing Address - Fax:706-364-0036
Practice Address - Street 1:3630 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6561
Practice Address - Country:US
Practice Address - Phone:706-922-0298
Practice Address - Fax:706-364-0036
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059596208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA084358075AMedicaid
GA084358075BMedicaid
GA084358075DMedicaid
SCG59596Medicaid
GAP00437594OtherRAILROAD MEDICARE
GA084358075AMedicaid
GA202I252574Medicare PIN