Provider Demographics
NPI:1336197755
Name:MCKERNAN, JOHN BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BARRY
Last Name:MCKERNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6442
Mailing Address - Country:US
Mailing Address - Phone:770-924-8808
Mailing Address - Fax:770-924-8266
Practice Address - Street 1:2001 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6442
Practice Address - Country:US
Practice Address - Phone:770-924-8808
Practice Address - Fax:770-924-8266
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024838174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist