Provider Demographics
NPI:1053075333
Name:BARFIELD, ELLEN KENNEDY (LMT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:KENNEDY
Last Name:BARFIELD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 GLEN RAVEN CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1501
Mailing Address - Country:US
Mailing Address - Phone:404-749-7671
Mailing Address - Fax:
Practice Address - Street 1:4366 GLEN RAVEN CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1501
Practice Address - Country:US
Practice Address - Phone:404-749-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012385225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist