Provider Demographics
NPI:1114225158
Name:BARNES, EARL GLENN (EDD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:GLENN
Last Name:BARNES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1036
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-1036
Mailing Address - Country:US
Mailing Address - Phone:615-202-2928
Mailing Address - Fax:
Practice Address - Street 1:213 CHAPELWOOD DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-6614
Practice Address - Country:US
Practice Address - Phone:615-202-0928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I684430Medicare PIN
TN103I681506Medicare PIN