Provider Demographics
NPI:1992877468
Name:BARNWELL, CRYSTAL (MD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:BARNWELL
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 1:5040 SNAPFINGER WOODS DR
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4020
Mailing Address - Country:US
Mailing Address - Phone:770-808-8500
Mailing Address - Fax:678-990-7511
Practice Address - Street 1:5040 SNAPFINGER WOODS DR
Practice Address - Street 2:SUITE 201A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4020
Practice Address - Country:US
Practice Address - Phone:770-808-8500
Practice Address - Fax:678-990-7511
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA042997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00834061BMedicaid
GA00834061BMedicaid
GAH00711Medicare UPIN