Provider Demographics
NPI:1033709043
Name:BARRY MEDICAL CLINIC
Entity Type:Organization
Organization Name:BARRY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-880-9990
Mailing Address - Street 1:1825 MOUNTAIN LAKE DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4030 LAWRENCEVILLE HWY NW STE 9
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2823
Practice Address - Country:US
Practice Address - Phone:678-880-9990
Practice Address - Fax:678-880-8834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K LOOR MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty