Provider Demographics
NPI:1922096882
Name:HULL, BARRY KENTON (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:KENTON
Last Name:HULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HABERSHAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:678-788-7500
Mailing Address - Fax:678-788-7501
Practice Address - Street 1:115 HABERSHAM DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:678-788-7500
Practice Address - Fax:678-788-7501
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E29054Medicare UPIN
GA08BBDSZMedicare PIN