Provider Demographics
NPI:1578571592
Name:BARRETT, GARY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOSEPH
Last Name:BARRETT
Suffix:
Gender:M
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-756-8090
Mailing Address - Fax:843-756-6122
Practice Address - Street 1:3109 CASEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2807
Practice Address - Country:US
Practice Address - Phone:843-756-8090
Practice Address - Fax:843-756-6122
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC11051207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08905123OtherNC MDCAID
SCGB0648Medicaid
SCGB0648Medicaid