Andrew Paul Barak, DO
Individual provider Active NPI Otolaryngology Physician · Douglasville, GA
NPI 1508824152 · NPPES record last updated Apr 20, 2022
Key facts
- NPI
- 1508824152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- License
- 67354 (GA)
- Practice address
- 6130 Prestley Mill Rd Ste C
Douglasville, GA 30134-2288 - Phone
- (678) 838-3903
- Fax
- (678) 838-7454
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Otolaryngology
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northside Surgical Professional Services LLC
Ear, Nose and Throat Plastic Surgery Center
Practice addresses (Care Compare)
1000 Johnson Ferry NE
Atlanta, GA 30342-1606
1000 Johnson Ferry Rd NE
Atlanta, GA 30342-1606
Phone (404) 851-8000
6130 Prestley Mill Rd
Suite C
Douglasville, GA 30134-2288
Phone (678) 838-3903
6130 Prestley Mill Rd C
Douglasville, GA 30134-2288
Hospital & facility affiliations
- Wellstar Cobb Medical Center
- Wellstar Douglas Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120307000770 | GA | Practitioner - Otolaryngology | 5597824151 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 67354 | GA | MD | Otolaryngology Physician |
| AB007458 | MI | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northside Surgical Professional Services LLC | Current |
Accepting new patients | |
| Ear, Nose & Throat Plastic Surgery Center | Current |
Accepting new patients |
Locations
1668 Mulkey Rd
Ste 132
Austell, GA 30106
6130 Prestley Mill Rd
Ste C
Douglasville, GA 30134
Phone (678) 838-3903
1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | AB007458 | MI | |
| Otolaryngology Physician | 207Y00000X | 67354 | GA | Yes |
Addresses
Primary practice location
6130 Prestley Mill Rd Ste C
Douglasville, GA 30134-2288
Mailing address
2323 E Paris Ave SE
Ste 102
Grand Rapids, MI 49546-2414
Phone (616) 285-3733
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003126984D | Medicaid | GA | |
| 2121408 | Medicaid | MI | |
| 0454110994 | Other | MI | BCBS |
Other providers in Douglasville, GA
- Michele Balthrope
- Quiera Banks
- Shahagony Banks
- Stephanie Banks
- Bhumika Banugaria
- Keturah Barnard
- Ivorine Barnes
- Walida S Barr
- Laurel Ann Barras
- Patricia Annette Barrett
All providers in Douglasville, GA · Otolaryngology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.