Healthcare Provider Details

I. General information

NPI: 1285966259
Provider Name (Legal Business Name): BARNES DRUG STORES OF VALDOSTA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 POWERS FERRY RD SE SUITE 325
ATLANTA GA
30339-2823
US

IV. Provider business mailing address

PO BOX 1187
VALDOSTA GA
31603-1187
US

V. Phone/Fax

Practice location:
  • Phone: 678-627-0077
  • Fax:
Mailing address:
  • Phone: 229-245-6001
  • Fax: 888-276-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2010#135758
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHHHH000048
License Number StateGA

VIII. Authorized Official

Name: CHARLES BARNES IV
Title or Position: OWNER/CEO
Credential:
Phone: 229-245-6001