Provider Demographics
NPI:1639391576
Name:BARNETT, JEFFERY (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:BARNETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SWEET BAY CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6784
Mailing Address - Country:US
Mailing Address - Phone:229-985-3367
Mailing Address - Fax:229-890-8129
Practice Address - Street 1:5 SWEET BAY CT
Practice Address - Street 2:SUITE A
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6784
Practice Address - Country:US
Practice Address - Phone:229-985-3367
Practice Address - Fax:229-890-8129
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice