Healthcare Provider Details

I. General information

NPI: 1003923145
Provider Name (Legal Business Name): CAROLYN BARNWELL PETREY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 GRAYSON HWY FAMILY PRACTICE CLINIC PC
LAWRENCEVILLE GA
30046-6372
US

IV. Provider business mailing address

696 GRAYSON HIGHWAY FAMILY PRACTICE CLINIC PC
LAWRENCEVILLE GA
30046-6372
US

V. Phone/Fax

Practice location:
  • Phone: 770-963-0927
  • Fax: 770-963-9772
Mailing address:
  • Phone: 770-963-0927
  • Fax: 770-963-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number026914
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: