Provider Demographics
NPI:1376939173
Name:BARNES, NICHOLAS TANNER (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TANNER
Last Name:BARNES
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 1:6696 US HIGHWAY 20A
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-9799
Mailing Address - Country:US
Mailing Address - Phone:198-223-2424
Mailing Address - Fax:419-822-9008
Practice Address - Street 1:6696 US HIGHWAY 20A
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-9799
Practice Address - Country:US
Practice Address - Phone:419-822-3242
Practice Address - Fax:419-822-9008
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013236207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program