1720389968 NPI number — MRS. BONNIE LOU BARAKAT-SMITH MS

Table of content: MRS. BONNIE LOU BARAKAT-SMITH MS (NPI 1720389968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720389968 NPI number — MRS. BONNIE LOU BARAKAT-SMITH MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARAKAT-SMITH
Provider First Name:
BONNIE
Provider Middle Name:
LOU
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720389968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1997 HIGHWAY 51 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38019-3630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-476-8967
Provider Business Mailing Address Fax Number:
901-746-2498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5281 NAVY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLINGTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38053-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-873-0305
Provider Business Practice Location Address Fax Number:
901-873-0306
Provider Enumeration Date:
11/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PE0000001693 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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