Provider Demographics
NPI:1922206119
Name:BARROW, OVID STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:OVID
Middle Name:STEPHEN
Last Name:BARROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 NORTHLAKE PKWY
Mailing Address - Street 2:BLDG. 3, STE 114
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4104
Mailing Address - Country:US
Mailing Address - Phone:770-559-1523
Mailing Address - Fax:770-864-1658
Practice Address - Street 1:2171 NORTHLAKE PKWY
Practice Address - Street 2:BLDG. 3, STE 114
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4104
Practice Address - Country:US
Practice Address - Phone:770-559-1523
Practice Address - Fax:770-864-1658
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA472629001-FMedicaid
GA202I115683Medicare PIN
GA20270G8044Medicare UPIN
GA202I114288Medicare PIN
GA472629001AMedicaid