Provider Demographics
NPI:1811325673
Name:BAKER, JANNA LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:LEIGH
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HAWTHORNE AVE STE T
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2168
Mailing Address - Country:US
Mailing Address - Phone:706-248-6860
Mailing Address - Fax:706-248-6142
Practice Address - Street 1:1000 HAWTHORNE AVE STE T
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2168
Practice Address - Country:US
Practice Address - Phone:706-248-6860
Practice Address - Fax:706-248-6860
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006974363A00000X
MO2016033035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant