Healthcare Provider Details

I. General information

NPI: 1174884233
Provider Name (Legal Business Name): T ELLIS BARNES IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 REYNOLDS STREET STE #202
SAVANNAH GA
31405
US

IV. Provider business mailing address

P.O. BOX 919
RINCON GA
31326-0919
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-0920
  • Fax: 912-826-2853
Mailing address:
  • Phone: 912-826-4057
  • Fax: 912-826-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number81556
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: