Provider Demographics
NPI:1730476169
Name:FALLIN, BARBARA A (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:A
Last Name:FALLIN
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-5248
Mailing Address - Country:US
Mailing Address - Phone:229-567-4414
Mailing Address - Fax:229-567-4419
Practice Address - Street 1:317 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-5248
Practice Address - Country:US
Practice Address - Phone:229-567-4414
Practice Address - Fax:229-567-4419
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001290363LF0000X
GARN123630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1730476169Medicaid