Healthcare Provider Details

I. General information

NPI: 1164571162
Provider Name (Legal Business Name): JOSEPH E. BARCLAY D.D.S., P.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206B SHERWOOD PARK DR NE
GAINESVILLE GA
30501-3445
US

IV. Provider business mailing address

1206B SHERWOOD PARK DR NE
GAINESVILLE GA
30501-3445
US

V. Phone/Fax

Practice location:
  • Phone: 770-535-2220
  • Fax: 770-535-7219
Mailing address:
  • Phone: 770-535-2220
  • Fax: 770-535-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDNC000059
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: