Provider Demographics
NPI:1558401992
Name:BARLOW, ROGER DARNELL
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:DARNELL
Last Name:BARLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4176
Mailing Address - Country:US
Mailing Address - Phone:229-382-7323
Mailing Address - Fax:229-382-7375
Practice Address - Street 1:1499 KENNEDY RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4176
Practice Address - Country:US
Practice Address - Phone:229-382-7323
Practice Address - Fax:229-382-7375
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA581814761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist