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General NPI Number Information
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NPI Number | 1407163595
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Entity Type | Organization
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Legal Business Name | BARR ENTERPRISES,LLC
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 09/10/2010
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Provider Practice Location Address
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Address Line | 112 NORSE DR
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City | COLUMBIA
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State | SC
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Zip | 29229-3304
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Country | US
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Telephone | 803-466-6207
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Fax | 803-736-0442
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Provider Business Mailing Address
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Address Line | 112 NORSE DR
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City | COLUMBIA
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State | SC
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Zip | 29229-3304
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Country | US
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Telephone | 803-466-6207
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Fax | 803-736-0442
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICKY LADD
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Credential | MD
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Telephone | 803-736-0442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 20616
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License Number State | SC
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