Provider Demographics
NPI:1174514970
Name:BARRETT, STEPHEN L (DPM, FACFAS, MBA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DPM, FACFAS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 DOWNWOOD CIR NW STE 520A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1610
Mailing Address - Country:US
Mailing Address - Phone:404-228-9892
Mailing Address - Fax:
Practice Address - Street 1:2520 WINDY HILL RD SE STE 205
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8650
Practice Address - Country:US
Practice Address - Phone:404-228-9892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0924213E00000X
AZ0557213E00000X
GAPOD000822213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I484280Medicare PIN