Healthcare Provider Details

I. General information

NPI: 1306065255
Provider Name (Legal Business Name): BARNES DRUG STORES OF VALDOSTA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 US HIGHWAY 41 N UNIT K
TIFTON GA
31794-2767
US

IV. Provider business mailing address

PO BOX 1187
VALDOSTA GA
31603-1187
US

V. Phone/Fax

Practice location:
  • Phone: 229-391-9114
  • Fax: 229-391-9265
Mailing address:
  • Phone: 229-245-6039
  • Fax: 888-276-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHARLES W BARNES IV
Title or Position: CEO AND OWNER
Credential:
Phone: 229-245-6039