Healthcare Provider Details

I. General information

NPI: 1407849037
Provider Name (Legal Business Name): JERRY OWEN BARRETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26303 SAVINGS CENTER DR
ARDMORE TN
38449-3273
US

IV. Provider business mailing address

PO BOX 235
ARDMORE TN
38449-0235
US

V. Phone/Fax

Practice location:
  • Phone: 931-427-3565
  • Fax: 931-427-8111
Mailing address:
  • Phone: 931-427-3565
  • Fax: 931-427-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD011762
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: