Provider Demographics
NPI:1790841120
Name:DAMPOG, BARBARA A (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:DAMPOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6179 WINDSONG WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1945
Mailing Address - Country:US
Mailing Address - Phone:770-923-5495
Mailing Address - Fax:
Practice Address - Street 1:3300 BUCKEYE RD
Practice Address - Street 2:SUITE 178
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4229
Practice Address - Country:US
Practice Address - Phone:770-458-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018136207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000266175CMedicaid
GAE81778Medicare UPIN
GA69WBDLRMedicare ID - Type Unspecified