MEDICARE: DALTON BARRIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356892483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALTON BARRIER

Provider Business Mailing Address
First Line	:	350 LAKE FORREST RD
Second Line	:
City	:	LYNCHBURG
State	:	TN
Zip	:	37352-5991
Country	:	US
Telephone Number	:	931-307-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 LAKE FORREST RD
Second Line	:
City	:	LYNCHBURG
State	:	TN
Zip	:	37352-5991
Country	:	US
Telephone Number	:	931-307-4590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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