Provider Demographics
NPI:1588637771
Name:BARRETT, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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:843-662-1533
Mailing Address - Fax:843-679-7273
Practice Address - Street 1:101 SOUTH RAVENEL STREET
Practice Address - Street 2:STE 160
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2635
Practice Address - Country:US
Practice Address - Phone:843-662-1533
Practice Address - Fax:843-679-7273
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT10057Medicaid
SCT10057Medicaid
SCF357158552Medicare ID - Type Unspecified