Provider Demographics
NPI:1417602558
Name:BARTIK, RENEE IRBY (RN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:IRBY
Last Name:BARTIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:IRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1331 HELEN HWY
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-2834
Mailing Address - Country:US
Mailing Address - Phone:706-865-2191
Mailing Address - Fax:706-865-7745
Practice Address - Street 1:1331 HELEN HWY
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-2834
Practice Address - Country:US
Practice Address - Phone:706-865-2191
Practice Address - Fax:706-865-7745
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118207163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA342691Medicaid
GA000058638AMedicaid
GA000442945OMedicaid
GA000924679BMedicaid
GA000456442AMedicaid
GA000051972NMedicaid
GA10044067Medicaid