Provider Demographics
NPI:1972332328
Name:BARNARD, KETURAH
Entity type:Individual
Prefix:
First Name:KETURAH
Middle Name:
Last Name:BARNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8697 HOSPITAL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2220
Mailing Address - Country:US
Mailing Address - Phone:404-402-9985
Mailing Address - Fax:
Practice Address - Street 1:8697 HOSPITAL DR STE 202
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2220
Practice Address - Country:US
Practice Address - Phone:404-402-9985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist