Provider Demographics
NPI:1679529465
Name:BARBER, THOMAS SCOTT (PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SCOTT
Last Name:BARBER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 4070
Mailing Address - Street 2:
Mailing Address - City:ALAPAHA
Mailing Address - State:GA
Mailing Address - Zip Code:31622-9602
Mailing Address - Country:US
Mailing Address - Phone:229-468-0632
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 4070
Practice Address - Street 2:
Practice Address - City:ALAPAHA
Practice Address - State:GA
Practice Address - Zip Code:31622-9602
Practice Address - Country:US
Practice Address - Phone:229-468-0632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA854441330AMedicaid
GAP80721Medicare UPIN