Provider Demographics
NPI:1407355597
Name:BARKER, CHANNING ELYSE (MD)
Entity type:Individual
Prefix:DR
First Name:CHANNING
Middle Name:ELYSE
Last Name:BARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHANNING
Other - Middle Name:
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:764 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2107
Mailing Address - Country:US
Mailing Address - Phone:478-633-1721
Mailing Address - Fax:
Practice Address - Street 1:764 PINE STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2107
Practice Address - Country:US
Practice Address - Phone:478-633-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC83334171000000X
GA16346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171000000XOther Service ProvidersMilitary Health Care Provider