Healthcare Provider Details

I. General information

NPI: 1801010293
Provider Name (Legal Business Name): LARRY BARNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WESTERN BLVD
JACKSONVILLE NC
28546-6341
US

IV. Provider business mailing address

325 WESTERN BLVD
JACKSONVILLE NC
28546-6341
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-1555
  • Fax: 910-577-1841
Mailing address:
  • Phone: 910-577-1555
  • Fax: 910-577-1841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number26184
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: