1689920167 NPI number — MS. CAROLYN PATRICIA BARNES PSY. D.

Table of content: MS. CAROLYN PATRICIA BARNES PSY. D. (NPI 1689920167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689920167 NPI number — MS. CAROLYN PATRICIA BARNES PSY. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNES
Provider First Name:
CAROLYN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PSY. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOFSTETTER
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689920167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1090 FOUNDERS BLVD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30606-6163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-548-8697
Provider Business Mailing Address Fax Number:
706-548-8698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1090 FOUNDERS BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-6163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-548-8697
Provider Business Practice Location Address Fax Number:
706-548-8698
Provider Enumeration Date:
08/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY003585 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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