Provider Demographics
NPI:1518723642
Name:BARRETT, DUWAYNE (RN)
Entity Type:Individual
Prefix:
First Name:DUWAYNE
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4827 OLD NATIONAL HWY # 1266
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-6234
Mailing Address - Country:US
Mailing Address - Phone:470-521-5799
Mailing Address - Fax:
Practice Address - Street 1:4291 STONEWALL TELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-1542
Practice Address - Country:US
Practice Address - Phone:470-521-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN276495163WA2000X, 163WC0400X, 163WC1500X, 163WD0400X, 163WH0200X, 163WN1003X, 163WP0809X, 374T00000X, 163W00000X
GARN276496163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel