Healthcare Provider Details

I. General information

NPI: 1356378350
Provider Name (Legal Business Name): DARA JEWELL BARRON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNITED STATES PENITENTIARY ATLANTA, 601 MCDONOUGH BLVD SE
ATLANTA GA
30315
US

IV. Provider business mailing address

625 NINAS TRCE SW
ATLANTA GA
30331-2039
US

V. Phone/Fax

Practice location:
  • Phone: 404-635-5100
  • Fax:
Mailing address:
  • Phone: 404-321-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number10533
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number61891
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number010533
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: