Provider Demographics
NPI:1215948492
Name:BAKER, NORMAN D JR (DO)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:D
Last Name:BAKER
Suffix:JR
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3642 SUNSET POINT DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-5003
Mailing Address - Country:US
Mailing Address - Phone:770-267-1789
Mailing Address - Fax:
Practice Address - Street 1:604 GREEN ST NE STE 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-267-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2213207P00000X
GA053665207Q00000X
KY04077207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ030500OtherTENNESSEE MEDICAID