Provider Demographics
NPI:1265595839
Name:BARRON, JOHN BRANDON (MED)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRANDON
Last Name:BARRON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ALDEN AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2007
Mailing Address - Country:US
Mailing Address - Phone:404-543-5434
Mailing Address - Fax:404-876-2909
Practice Address - Street 1:5041 DALLAS HWY
Practice Address - Street 2:SUITE 704-C
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6458
Practice Address - Country:US
Practice Address - Phone:678-331-3041
Practice Address - Fax:404-876-2909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00935591AMedicaid
FLSLP004105OtherSPEECH THERAPY LICENSE