MEDICARE: ALISON DRAKE-BARRACK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	038736	GA

General Provider Information

NPI Number	:	1457354185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON DRAKE-BARRACK M.D.

Provider Business Mailing Address
First Line	:	1230 JOHNSON FERRY PL
Second Line	:	SUITE H 15
City	:	MARIETTA
State	:	GA
Zip	:	30068-2048
Country	:	US
Telephone Number	:	678-738-7601
Fax Number	:	678-738-7605

Provider Business Practice Location Address
First Line	:	1230 JOHNSON FERRY PL
Second Line	:	SUITE H 15
City	:	MARIETTA
State	:	GA
Zip	:	30068-2048
Country	:	US
Telephone Number	:	678-738-7601
Fax Number	:	678-738-7605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/02/2010

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