Provider Demographics
NPI:1114754769
Name:ATKINS, BARRY LINCOLN (CSFR)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:LINCOLN
Last Name:ATKINS
Suffix:
Gender:M
Credentials:CSFR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 REMBRANDT AVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5022
Mailing Address - Country:US
Mailing Address - Phone:904-735-3838
Mailing Address - Fax:
Practice Address - Street 1:716 REMBRANDT AVE
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5022
Practice Address - Country:US
Practice Address - Phone:904-735-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
153853246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant