Provider Demographics
NPI:1003923145
Name:PETREY, CAROLYN BARNWELL (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:BARNWELL
Last Name:PETREY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:696 GRAYSON HIGHWAY
Mailing Address - Street 2:FAMILY PRACTICE CLINIC PC
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-6372
Mailing Address - Country:US
Mailing Address - Phone:770-963-0927
Mailing Address - Fax:770-963-9772
Practice Address - Street 1:696 GRAYSON HWY
Practice Address - Street 2:FAMILY PRACTICE CLINIC PC
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-6372
Practice Address - Country:US
Practice Address - Phone:770-963-0927
Practice Address - Fax:770-963-9772
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00302222AMedicaid
$$$$$$$$$AMedicare PIN
GA00302222AMedicaid