Provider Demographics
NPI:1720224850
Name:BARRERA, NOELLEMARIE (DO)
Entity Type:Individual
Prefix:
First Name:NOELLEMARIE
Middle Name:
Last Name:BARRERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:MARIE
Other - Last Name:BARRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1325 ROCK QUARRY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5088
Mailing Address - Country:US
Mailing Address - Phone:770-389-0734
Mailing Address - Fax:
Practice Address - Street 1:1325 ROCK QUARRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5088
Practice Address - Country:US
Practice Address - Phone:770-389-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72555207R00000X
FLOS11804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
001700508Medicare UPIN