Provider Demographics
NPI:1558319301
Name:EBERT, BARBARA EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:EILEEN
Last Name:EBERT
Suffix:
Gender:F
Credentials:MD
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 3864
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-3864
Mailing Address - Country:US
Mailing Address - Phone:229-502-9710
Mailing Address - Fax:
Practice Address - Street 1:760 26TH AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6799
Practice Address - Country:US
Practice Address - Phone:229-502-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071730207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147858DMedicaid
GA202I075536OtherMEDICARE PTAN
GA003147858BMedicaid
MO004013060Medicare PIN
MO151068OtherBLUE SHIELD/BLUE CHOICE
MO300272OtherUNITED HEALTHCARE
MOP00419273Medicare PIN
MO966365236Medicare PIN
F45017Medicare UPIN
MO038011443Medicare PIN