Provider Demographics
NPI:1164200333
Name:BARNES, BRIAN JEFFERY
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JEFFERY
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 SILVERLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-7495
Mailing Address - Country:US
Mailing Address - Phone:478-595-7452
Mailing Address - Fax:
Practice Address - Street 1:1136 SILVERLEAF CIR
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-7495
Practice Address - Country:US
Practice Address - Phone:478-595-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)