Healthcare Provider Details

I. General information

NPI: 1982655841
Provider Name (Legal Business Name): FREDDIE THOMAS BARRON M.D..
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 DANNAHER DR
POWELL TN
37849-4039
US

IV. Provider business mailing address

7730 DANNAHER DR
POWELL TN
37849-4039
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-7107
  • Fax: 865-524-3709
Mailing address:
  • Phone: 865-524-7107
  • Fax: 865-524-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD0000009880
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: