Doctor Name: | MR. JERRY OWEN BARRETT |
NPI Number: | 1407849037 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | MD011762 |
Business Practice Address: | 26303 Savings Center Dr Ardmore, TN - 384493273 |
Business Phone Number: | 9314273565 |
Business Fax Number: | 9314278111 |
Mailing Address: | Po Box 235, ARDMORE |
State: | TN |
Postal Code: | 384490235 |
Phone Number: | 9314273565 |
Fax Number: | 9314278111 |
NPI Enumeration Date: | 08/30/2005 |
NPI Last Update Date: | 05/26/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD011762 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |