Provider Demographics
NPI:1881600906
Name:BRUCE, BARBARA A (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:A
Last Name:BRUCE
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 1:3890 REDWINE RD SW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5582
Mailing Address - Country:US
Mailing Address - Phone:404-629-4740
Mailing Address - Fax:404-629-4749
Practice Address - Street 1:3890 REDWINE RD SW
Practice Address - Street 2:SUITE 104
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5582
Practice Address - Country:US
Practice Address - Phone:404-629-4740
Practice Address - Fax:404-629-4749
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD151232084N0402X
GA643382084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07789240Medicaid
LA1065773Medicaid
MS302I370367Medicare PIN