Provider Demographics
NPI:1184665846
Name:BARRON, BRUCE J (MD, MHA)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:BARRON
Suffix:
Gender:M
Credentials:MD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:404-686-1248
Mailing Address - Fax:404-686-4982
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-686-1248
Practice Address - Fax:404-686-4982
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG09432085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138263201OtherCSHCN
TX138263210Medicaid
TX82341ROtherBCBS
E38826Medicare UPIN
TX138263201OtherCSHCN
TX138263210Medicaid