Healthcare Provider Details

I. General information

NPI: 1699916528
Provider Name (Legal Business Name): CRISPIN OLUKEMI BARLATT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 NOAH DR
JASPER GA
30143-8721
US

IV. Provider business mailing address

1500 1ST AVE N UNIT 3
BIRMINGHAM AL
35203-1866
US

V. Phone/Fax

Practice location:
  • Phone: 706-253-1954
  • Fax:
Mailing address:
  • Phone: 205-545-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number010638
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79934
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: