Basic Information
| Provider Information | |||||||||
| NPI: | 1598879108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARNETT | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3525 PIEDMONT RD NE | ||||||||
| Address2: | BLDG 7 SUITE 601 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048425400 | ||||||||
| FaxNumber: | 4048488669 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 COLLIER RD NW | ||||||||
| Address2: | SUITE 1020 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043512112 | ||||||||
| FaxNumber: | 4043517211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 015350 | GA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00118698A | 05 | GA | MEDICAID |