Provider Demographics
NPI:1356988455
Name:BARRETT, MAURA MCHUGH (PAC)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:MCHUGH
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 MATHEWS AVE NE APT A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2338
Mailing Address - Country:US
Mailing Address - Phone:412-612-0419
Mailing Address - Fax:
Practice Address - Street 1:1805 PARKE PLAZA CIR STE 103
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3646
Practice Address - Country:US
Practice Address - Phone:770-498-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-08
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9569363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant