Provider Demographics
NPI:1093554610
Name:BARBER, ANGLEAN
Entity type:Individual
Prefix:MS
First Name:ANGLEAN
Middle Name:
Last Name:BARBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 GARDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-3354
Mailing Address - Country:US
Mailing Address - Phone:423-313-4408
Mailing Address - Fax:
Practice Address - Street 1:5726 BLACKBERRY ROW
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-4917
Practice Address - Country:US
Practice Address - Phone:423-313-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier