1699731240 NPI number — MR. TIMOTHY A. BARNES PA-C/SA

Table of content: MR. TIMOTHY A. BARNES PA-C/SA (NPI 1699731240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699731240 NPI number — MR. TIMOTHY A. BARNES PA-C/SA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNES
Provider First Name:
TIMOTHY
Provider Middle Name:
A.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C/SA
Provider Gender Code:
M

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:
1699731240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNISTON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-235-5860
Provider Business Mailing Address Fax Number:
256-235-5190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 LEIGHTON AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ANNISTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-236-1300
Provider Business Practice Location Address Fax Number:
256-236-0254
Provider Enumeration Date:
04/24/2006

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: 363AS0400X , with the licence number:  PA-4 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA-4 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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