MEDICARE: MR. JERRY OWEN BARRETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	MD011762	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000055623	OTHER	TN	BLUE CROSS

General Provider Information

NPI Number	:	1407849037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY OWEN BARRETT MD

Provider Business Mailing Address
First Line	:	PO BOX 235
Second Line	:
City	:	ARDMORE
State	:	TN
Zip	:	38449-0235
Country	:	US
Telephone Number	:	931-427-3565
Fax Number	:	931-427-8111

Provider Business Practice Location Address
First Line	:	26303 SAVINGS CENTER DR
Second Line	:
City	:	ARDMORE
State	:	TN
Zip	:	38449-3273
Country	:	US
Telephone Number	:	931-427-3565
Fax Number	:	931-427-8111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	05/26/2011

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