Healthcare Provider Details

I. General information

NPI: 1962426890
Provider Name (Legal Business Name): MICHAEL JOHN BARON MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6107 PINEWOOD RD
NUNNELLY TN
37137-2523
US

IV. Provider business mailing address

6107 PINEWOOD RD
NUNNELLY TN
37137-2523
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-9728
  • Fax: 931-729-7272
Mailing address:
  • Phone: 931-729-9728
  • Fax: 931-729-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD21339
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD.018736
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberR6G18
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: