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Individual

ANTWAN LAJUNNE BAKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
AGACNP-BC

Contact information

Practice address
865 S 1ST ST, JESUP, GA 31545-0210
(912) 427-6811
Mailing address
278 AMY CLEGG DR, GRAY, GA 31032-4747
(478) 960-7232

Taxonomy

Speciality
Code
Description
License number
State
364SA2100X
Acute Care Clinical Nurse Specialist
Primary
NCO-000003
GA

Other

Enumeration date
10/21/2019
Last updated
10/21/2019
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