Provider Demographics
NPI:1376734533
Name:LATHROP, BARBARA W (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:W
Last Name:LATHROP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 3RD ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3293
Mailing Address - Country:US
Mailing Address - Phone:478-745-6576
Mailing Address - Fax:478-746-0018
Practice Address - Street 1:610 3RD ST
Practice Address - Street 2:STE 101
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3293
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112839363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA871088793BMedicaid
GAML1904122OtherDEA
GA511I500751Medicare PIN