1235338369 NPI number — MS. GEORGIA CAROL BARBOUR RN, LCSW

Table of content: MS. GEORGIA CAROL BARBOUR RN, LCSW (NPI 1235338369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235338369 NPI number — MS. GEORGIA CAROL BARBOUR RN, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARBOUR
Provider First Name:
GEORGIA
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOUTHARD
Provider Other First Name:
GEORGIA
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235338369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 FORT SANDERS WEST BLVD
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37922-3398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-531-4500
Provider Business Mailing Address Fax Number:
865-531-4584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 FORT SANDERS WEST BLVD
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37922-3398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-531-4500
Provider Business Practice Location Address Fax Number:
865-531-4584
Provider Enumeration Date:
07/18/2007

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: 1041C0700X , with the licence number:  LSW0000000714 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN0000135558 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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