Provider Demographics
NPI:1588825699
Name:CORTIS, BARRY A (DO)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:CORTIS
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 1:10054 OLD TULLAHOMA RD
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-6122
Mailing Address - Country:US
Mailing Address - Phone:931-967-8641
Mailing Address - Fax:931-455-0892
Practice Address - Street 1:10054 OLD TULLAHOMA RD
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-6122
Practice Address - Country:US
Practice Address - Phone:931-967-8641
Practice Address - Fax:931-455-0892
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527290Medicaid