1457533655 NPI number — MRS. VENILLA R BARNES DPT

Table of content: MRS. VENILLA R BARNES DPT (NPI 1457533655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457533655 NPI number — MRS. VENILLA R BARNES DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNES
Provider First Name:
VENILLA
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIBSON
Provider Other First Name:
VENILLA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457533655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 COMMERCE DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-692-1654
Provider Business Mailing Address Fax Number:
404-393-4044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 COMMERCE DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214-7352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-692-1654
Provider Business Practice Location Address Fax Number:
404-393-4044
Provider Enumeration Date:
11/29/2007

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: 225100000X , with the licence number:  2305205271 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT009550 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 192951 . This is a "BCBS PHYSICAL THERAPY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9521078 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1457533655 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00467142 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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