Provider Demographics
NPI:1598716466
Name:BARRY, AMY (CPNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GARTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:1405 CLIFTON RD
Mailing Address - Street 2:CHILDRENS HEALTHCARE OF ATLANTA 3RD FLOOR BMT OFFICE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-257-3240
Mailing Address - Fax:404-250-2781
Practice Address - Street 1:1405 CLIFTON RD
Practice Address - Street 2:3RD FLOOR BMT OFFICE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-785-3544
Practice Address - Fax:404-785-3544
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA156491207RH0003X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000933985Medicaid