Provider Demographics
NPI:1164644019
Name:JEFFERY P. BARNETT, D.M.D., P.C.
Entity Type:Organization
Organization Name:JEFFERY P. BARNETT, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-985-3367
Mailing Address - Street 1:5 SWEET BAY CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 SWEET BAY CT
Practice Address - Street 2:SUITE A
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6784
Practice Address - Country:US
Practice Address - Phone:229-985-3367
Practice Address - Fax:229-890-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty