Provider Demographics
NPI:1164462107
Name:BARNES, STEPHEN N (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:N
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 RIVERSIDE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1395
Mailing Address - Country:US
Mailing Address - Phone:478-474-2114
Mailing Address - Fax:478-474-5043
Practice Address - Street 1:4664 RIVERSIDE PARK BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1397
Practice Address - Country:US
Practice Address - Phone:478-474-2114
Practice Address - Fax:478-474-5043
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014151207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00199031BMedicaid
D39350Medicare UPIN