Provider Demographics
NPI:1174528673
Name:MCLEOD-HUGHES, BARRY (PT)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:MCLEOD-HUGHES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 S HOUSTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9017
Mailing Address - Country:US
Mailing Address - Phone:478-971-7033
Mailing Address - Fax:
Practice Address - Street 1:624 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9017
Practice Address - Country:US
Practice Address - Phone:478-971-7033
Practice Address - Fax:478-971-7066
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003691174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116564Medicare Oscar/Certification