Provider Demographics
NPI:1770703720
Name:BARKER, MEREDITH SPANN (DMD)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:SPANN
Last Name:BARKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4077 QUAIL RUN CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-0184
Mailing Address - Country:US
Mailing Address - Phone:229-244-1633
Mailing Address - Fax:229-244-0661
Practice Address - Street 1:2311 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2510
Practice Address - Country:US
Practice Address - Phone:229-244-1633
Practice Address - Fax:229-244-0661
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO13235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist