Healthcare Provider Details

I. General information

NPI: 1770518045
Provider Name (Legal Business Name): GARIN DANIEL BARTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 WHITESVILLE ST
LAGRANGE GA
30240-5903
US

IV. Provider business mailing address

1605 WHITESVILLE ST
LAGRANGE GA
30240-5903
US

V. Phone/Fax

Practice location:
  • Phone: 706-882-5119
  • Fax: 706-882-0270
Mailing address:
  • Phone: 706-882-5119
  • Fax: 706-882-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number30949
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: