Provider Demographics
NPI:1568799476
Name:BARLET, BETH V (PA-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:V
Last Name:BARLET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MOHAWK ST STE E
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1768
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-925-2381
Practice Address - Street 1:176 DERMIS RD
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4161
Practice Address - Country:US
Practice Address - Phone:912-925-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005726363A00000X
SC363AM0700X
SC1499363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1000PAMedicaid
GA102946116AMedicaid
GAP00799590OtherRAILROAD MEDICARE
SC1000PAMedicaid
GA202I973440Medicare PIN
GA102946116AMedicaid