Provider Demographics
NPI:1780740183
Name:BARKER, JEAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:BARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-3267
Mailing Address - Country:US
Mailing Address - Phone:662-332-4114
Mailing Address - Fax:662-332-1149
Practice Address - Street 1:1659 EAST UNION STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703
Practice Address - Country:US
Practice Address - Phone:662-332-4114
Practice Address - Fax:662-332-1149
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019827Medicaid
MS080001411Medicare PIN
MS00019827Medicaid