Healthcare Provider Details

I. General information

NPI: 1528752318
Provider Name (Legal Business Name): DESIREE BARKSDALE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

1545 JONES RD
CATAULA GA
31804-4233
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRN236439
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN236439
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: