Healthcare Provider Details

I. General information

NPI: 1821039660
Provider Name (Legal Business Name): VINCENT B. BARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 COLUMBIA ST
BLAKELY GA
39823-2574
US

IV. Provider business mailing address

500 S CHESTNUT ST
ABERDEEN MS
39730-3337
US

V. Phone/Fax

Practice location:
  • Phone: 229-724-4282
  • Fax: 229-724-4283
Mailing address:
  • Phone: 662-369-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19004
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number066252
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: