Provider Demographics
NPI:1538290465
Name:BARNETT, JUDY L
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:BARNETT
Suffix:
Gender:F
Credentials:
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 856
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-0856
Mailing Address - Country:US
Mailing Address - Phone:843-248-3392
Mailing Address - Fax:
Practice Address - Street 1:1907 HIGHWAY 378
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-4905
Practice Address - Country:US
Practice Address - Phone:843-248-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies