Provider Demographics
NPI:1376754192
Name:HENNESSEY, BARRY J (DO)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:HENNESSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ENOCH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2231
Mailing Address - Country:US
Mailing Address - Phone:731-925-9909
Mailing Address - Fax:731-925-3323
Practice Address - Street 1:80 ENOCH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2231
Practice Address - Country:US
Practice Address - Phone:731-925-9909
Practice Address - Fax:731-925-3323
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1554207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722978Medicaid
TN3722978Medicare ID - Type UnspecifiedFACILITY PROVIDER #
TN3308011Medicare ID - Type Unspecified
TN3722978Medicaid