Provider Demographics
NPI:1568425122
Name:BARKER, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BARKER
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 1:1372 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:TN
Mailing Address - Zip Code:37301-3626
Mailing Address - Country:US
Mailing Address - Phone:931-692-3641
Mailing Address - Fax:931-692-2201
Practice Address - Street 1:1372 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:TN
Practice Address - Zip Code:37301-3626
Practice Address - Country:US
Practice Address - Phone:931-692-3641
Practice Address - Fax:931-692-2201
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-3076207VG0400X
TN11487207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106009001Medicaid
AR106009001Medicaid
ARB04705Medicare UPIN