Provider Demographics
NPI:1679695266
Name:BARTHOLOMEW, GARY A (DMD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9084
Mailing Address - Country:US
Mailing Address - Phone:770-507-7435
Mailing Address - Fax:770-507-6423
Practice Address - Street 1:350 COUNTRY CLUB DR
Practice Address - Street 2:SUITE E
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9084
Practice Address - Country:US
Practice Address - Phone:770-507-7435
Practice Address - Fax:770-507-6423
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice