Healthcare Provider Details

I. General information

NPI: 1659712578
Provider Name (Legal Business Name): PATRICK D. BARNES D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET UMMC: SCHOOL OF DENTISTRY
JACKSON MS
39216
US

IV. Provider business mailing address

285 ELM ST STE 301
CUMMING GA
30040-8233
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-1000
  • Fax:
Mailing address:
  • Phone: 770-888-7798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN014605
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN014605
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: