Individual
SALLY BROOKS BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 347-8103
Mailing address
PO BOX 70157, MYRTLE BEACH, SC 29572-0021
(843) 516-2024
(843) 796-1319
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
59842
TN
207Q00000X
Family Medicine Physician
Primary
84920
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207Q00000X
FAMILY MEDICINE
VA
Enumeration date
06/28/2016
Last updated
04/23/2021
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