Provider Demographics
NPI:1629378674
Name:BARRON, JACK JEROME (PERSONAL TRAINER)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:JEROME
Last Name:BARRON
Suffix:
Gender:M
Credentials:PERSONAL TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 LANTRAC CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4006
Mailing Address - Country:US
Mailing Address - Phone:770-593-8033
Mailing Address - Fax:770-593-3248
Practice Address - Street 1:2511 LANTRAC CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4006
Practice Address - Country:US
Practice Address - Phone:770-593-8033
Practice Address - Fax:770-593-3248
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No133N00000XDietary & Nutritional Service ProvidersNutritionist