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General NPI Number Information
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NPI Number | 1891536405
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Entity Type | Individual
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Provider Name | MICHAEL SHANE BARNES RT(R))CT)(MR)
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Gender | Male
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 1500 E WOODROW WILSON AVE
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City | JACKSON
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State | MS
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Zip | 39216-5116
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Country | US
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Telephone | 601-362-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 412 ROCKY POINT RD
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City | CARTHAGE
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State | MS
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Zip | 39051-8033
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Country | US
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Telephone | 601-940-8624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MRT-2012
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 2471M1202X
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Taxonomy Name | Magnetic Resonance Imaging Radiologic Technologist
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License Number |
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