Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 042013 | GA |
NPI | 1003817172 |
---|---|
Provider Name | Miss Lucretia Renee Barker |
First Address | Eastman, GA 31023-9012 |
Second Address | Eastman, GA 31023-9009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 26/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00791238A | (05) | GA |
G71129 | (02) | GA |