Provider Demographics
NPI:1760079206
Name:BARWICK, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:BARWICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CRESTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1411
Mailing Address - Country:US
Mailing Address - Phone:478-290-7244
Mailing Address - Fax:
Practice Address - Street 1:104 CRESTWOOD CT
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028-1411
Practice Address - Country:US
Practice Address - Phone:478-290-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist