Provider Demographics
NPI:1023480878
Name:BAKER, TERESA MICHELLE (LMT, EMT, CNA, AP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MICHELLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMT, EMT, CNA, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 BRITTAN GLADE TRL
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8717
Mailing Address - Country:US
Mailing Address - Phone:404-316-0006
Mailing Address - Fax:
Practice Address - Street 1:3961 BRITTAN GLADE TRL
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-8717
Practice Address - Country:US
Practice Address - Phone:404-316-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEMT545278146N00000X
FLDS2100020171W00000X
GAMT001411225700000X
FLCNA322852376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No171W00000XOther Service ProvidersContractor
No376K00000XNursing Service Related ProvidersNurse's Aide