Provider Demographics
NPI:1306405741
Name:BARNES, DYLAN MICHAELA KELLY (MD)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:MICHAELA KELLY
Last Name:BARNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 GLENRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1796
Mailing Address - Country:US
Mailing Address - Phone:314-402-9910
Mailing Address - Fax:
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD STE 910
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4789
Practice Address - Country:US
Practice Address - Phone:770-277-4277
Practice Address - Fax:404-252-5745
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL82794208600000X
GA100448208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery