1790713279 NPI number — MRS. KAREN G BARBER

Table of content: MRS. KAREN G BARBER (NPI 1790713279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790713279 NPI number — MRS. KAREN G BARBER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARBER
Provider First Name:
KAREN
Provider Middle Name:
G
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790713279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 877
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARPSBURG
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30277-0877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-254-9419
Provider Business Mailing Address Fax Number:
770-254-9419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1260 HIGHWAY 54 W
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214-4514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-392-7110
Provider Business Practice Location Address Fax Number:
770-254-9419
Provider Enumeration Date:
06/30/2006

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: 225100000X , with the licence number:  4808 , 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)

  • Identifier: 5709663 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00267638 . This is a "RAILROAD MEDICARE PROV." identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52672107004 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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