Provider Demographics
NPI:1932157690
Name:BARKLEY, REBECCA LYNN (DDS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:BARKLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 COMMERCE DR
Mailing Address - Street 2:STE 712
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030
Mailing Address - Country:US
Mailing Address - Phone:404-377-8200
Mailing Address - Fax:404-377-3604
Practice Address - Street 1:755 COMMERCE DR
Practice Address - Street 2:STE 712
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-377-8200
Practice Address - Fax:404-377-3604
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0097071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00268265AMedicaid