Provider Demographics
NPI:1417332503
Name:CIVILIAN BARBER SURGEONS
Entity Type:Organization
Organization Name:CIVILIAN BARBER SURGEONS
Other - Org Name:CIVILIAN BARBER SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASTER BARBER
Authorized Official - Prefix:PROF
Authorized Official - First Name:KARRIEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BARBER
Authorized Official - Phone:404-710-6136
Mailing Address - Street 1:8079 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3294
Mailing Address - Country:US
Mailing Address - Phone:404-710-6136
Mailing Address - Fax:
Practice Address - Street 1:8079 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3294
Practice Address - Country:US
Practice Address - Phone:404-710-6136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABR018793291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory