Provider Demographics
NPI:1487115119
Name:BARRETT, GREGORY STEWART (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:STEWART
Last Name:BARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7360
Mailing Address - Country:US
Mailing Address - Phone:678-237-6294
Mailing Address - Fax:
Practice Address - Street 1:612 W GORDON ST STE B
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3480
Practice Address - Country:US
Practice Address - Phone:706-648-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88217208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery