Provider Demographics
NPI:1760432272
Name:BARBARA-STARK, VIVIAN RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:RUTH
Last Name:BARBARA-STARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:RUTH
Other - Last Name:BARBARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3530 HABERSHAM ROAD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:678-249-4034
Mailing Address - Fax:404-841-0068
Practice Address - Street 1:1001 JOHNSON FERRY RD
Practice Address - Street 2:STE 1102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1605
Practice Address - Country:US
Practice Address - Phone:404-250-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics