Provider Demographics
NPI:1598111361
Name:BARR, WALIDA S (LPN)
Entity Type:Individual
Prefix:
First Name:WALIDA
Middle Name:S
Last Name:BARR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1614
Mailing Address - Country:US
Mailing Address - Phone:862-235-2284
Mailing Address - Fax:
Practice Address - Street 1:6804 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1614
Practice Address - Country:US
Practice Address - Phone:862-235-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN089480164W00000X
NJ26NP06965400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse