Provider Demographics
NPI:1326245366
Name:BARCLAY, ELISABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8440
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:200 WISTERIA DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3827
Practice Address - Country:US
Practice Address - Phone:770-219-5407
Practice Address - Fax:770-219-7102
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056406207Q00000X, 2084N0400X
PAMD45668302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA114802799AMedicaid
GAI40424Medicare UPIN
GA114802799AMedicaid