Healthcare Provider Details

I. General information

NPI: 1417010992
Provider Name (Legal Business Name): JEFFREY L. BARKSDALE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 GWINNETT DR
LAWRENCEVILLE GA
30045-8444
US

IV. Provider business mailing address

175 GWINNETT DR
LAWRENCEVILLE GA
30045-8444
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-5095
  • Fax: 678-990-3997
Mailing address:
  • Phone: 770-339-5095
  • Fax: 678-990-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW003134
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: