Provider Demographics
NPI:1033270889
Name:BARRON, PHILIP L (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:BARRON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 DANCY AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-3008
Mailing Address - Country:US
Mailing Address - Phone:912-927-9949
Mailing Address - Fax:
Practice Address - Street 1:842 DANCY AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-3008
Practice Address - Country:US
Practice Address - Phone:912-927-9949
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
GA1734103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00697496AMedicaid