Individual
JUSTIN DEION BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
720 WESTVIEW DR SW, ATLANTA, GA 30310-1458
(404) 616-6634
Mailing address
720 WESTVIEW DR SW, ATLANTA, GA 30310-1458
(404) 616-6634
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057038765
DRIVER'S LICENSE
GA
Enumeration date
09/12/2022
Last updated
09/12/2022
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