Healthcare Provider Details

I. General information

NPI: 1932045473
Provider Name (Legal Business Name): PRESTON JIM BARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 NORTHWOOD PARK DR
VALDOSTA GA
31602-1398
US

IV. Provider business mailing address

818 NORTHWOOD PARK DR
VALDOSTA GA
31602-1398
US

V. Phone/Fax

Practice location:
  • Phone: 229-247-0923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124239
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: