Provider Demographics
NPI:1164003141
Name:BARNES, GLENN COURTNEY (SLP)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:COURTNEY
Last Name:BARNES
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NORTHSIDE DR NW STE A7
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2695
Mailing Address - Country:US
Mailing Address - Phone:770-570-2140
Mailing Address - Fax:
Practice Address - Street 1:9765 WALNUT GROVE TRL
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-4190
Practice Address - Country:US
Practice Address - Phone:770-570-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty