Healthcare Provider Details

I. General information

NPI: 1861492829
Provider Name (Legal Business Name): MARJORIE LEE BARNETT MD MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 WEST 23RD ST
PANAMA CITY FL
32405
US

IV. Provider business mailing address

1901 1ST ST N APT 305
JACKSONVILLE BEACH FL
32250-8403
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-8341
  • Fax:
Mailing address:
  • Phone: 845-701-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number155839
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: