Healthcare Provider Details

I. General information

NPI: 1255906079
Provider Name (Legal Business Name): KATELYN BARCLAY N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 BILL GARDNER PKWY
LOCUST GROVE GA
30248-3644
US

IV. Provider business mailing address

4865 BILL GARDNER PKWY
LOCUST GROVE GA
30248-3644
US

V. Phone/Fax

Practice location:
  • Phone: 770-692-0100
  • Fax: 770-692-6190
Mailing address:
  • Phone: 404-641-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberRN301959
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: