Provider Demographics
NPI:1023179017
Name:BARKLEY, LAWAN ROBERTA
Entity Type:Individual
Prefix:MS
First Name:LAWAN
Middle Name:ROBERTA
Last Name:BARKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAWAN
Other - Middle Name:ROBERTA
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 GLENEAGLES DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8033
Mailing Address - Country:US
Mailing Address - Phone:404-314-1734
Mailing Address - Fax:
Practice Address - Street 1:79 GLENEAGLES DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-8033
Practice Address - Country:US
Practice Address - Phone:404-314-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor