Provider Demographics
NPI:1831600725
Name:BARNES, DYNIECIA
Entity type:Individual
Prefix:
First Name:DYNIECIA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5284 FLOYD RD SW UNIT 1669
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-6115
Mailing Address - Country:US
Mailing Address - Phone:678-615-6042
Mailing Address - Fax:
Practice Address - Street 1:2575 WHITE HAVEN DR SW
Practice Address - Street 2:STE 100 / SALON 121
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064
Practice Address - Country:US
Practice Address - Phone:770-799-6807
Practice Address - Fax:866-799-9972
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO1237111744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management