Provider Demographics
NPI:1538194634
Name:BARRETT, RICHARD JOHN JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:BARRETT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E. 72ND STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4913
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-5044
Practice Address - Street 1:102 BRYAN WOODS ROAD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-1225
Practice Address - Country:US
Practice Address - Phone:912-898-1122
Practice Address - Fax:912-898-9944
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00797673AMedicaid
GA52727492OtherBCBS GEORGIA
GA582393308OtherCOMMERCIAL, CHAMPVA
GA58239330831061OtherCHAMPUSTRICARETRICARLIFE
GA045719OtherMEDICAL LICENSE
GA045719OtherMEDICAL LICENSE
GA58239330831061OtherCHAMPUSTRICARETRICARLIFE
GA045719OtherMEDICAL LICENSE
GA110182786Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GA582393308OtherCOMMERCIAL, CHAMPVA